HomeMy WebLinkAboutMortgage_Sevier (5)�
^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
;;�'; FOR DEDUCTION FROM ASSESSED VALUAT� \^ �\
State Fortn 43709 (R11 / 6-09)
Presaibed Ey DepartmeM af Local Govemment Fvance d�
File Mark
INSTRUCTIONS: �
Form 0ed wiN:
To 6e filed in person w by mail with the CountyAuditor or Counry RecoNer of the counry where the pmperry is located.
Flirig Dates: 1) Real Pmperty: Must fik durirg the year for which Ihe deductbn is sotyht. unty Auditor
2) Mo6de / Manu/actured Homes nof assessed as Real Pmperty Must file dunng the hveNe (72) months ❑
befo,e Ma/ch 37 of each year the deductron is sought County Recorder
See reverse side /or addiLOn�((insWUions ryntl quali[catbns. � -
1 V2A1! Cf IC�I 7�P�Y 25 01
��
ro. what is his / her ezaG shara ol interasl?
tl fartre m remrd is Cifferent ihan
i�3Rlf 4� RbR '�2B IX C�f1I(aGt
-d o-a 3-/�
2 4NepICtlnE55 unp2id a5 of
�O C7�
cantraU s�er (nunber and streeG crN. state. ard LP oode�
r�me �e �� «a� �� a nde� m �wnya9e
ACdrea al assignce (number an0 stree; ary, state. artd LP cotle)
Does epqimnt awn poperty in any oticer If yes, what munyt
munryinlMiana? ❑ Yes ❑ No
Deduction aPWrn'ed'e� ihe amount of:
20 _ 20 � 20 _
�� ,
Sig�W2WCamNAWitw 1�
1/ We certify urWer the penaky of perjury that Ne above atW f,
owner ntracl buye of the aforementioned pmperty on date
g /'( �
W " enc o( eppfioni (wmDer antl sheef, dty, sfate nd P
j Pefson auNO�E Cy dWy ezecuted Povrer of Attomey rn by IC 61.1-12-0.7
�� ACEress ot auUroraed person (numbe� and sneet, cAy. stale. an0 LP mtle)
�aU� ll9- �o� � ���,..
�9age / ConbaG' ebteCness �m7� as of Lv Ne aPP�t the sde
� of eppfxatnn legal a equRade amell
❑ Yes ❑ No
someone I than spouse. irM'wa ' whan
!
Is Ihe pmp m questim: MnuaOy essed
� Real P �erty � ❑ Mnualh� ess�
I What Tadng D'aUict't I Has Iha ded��Cion Oeen re9uestetl m 7�P�Y
far artem Yralt ❑ Yes ❑ Ni
COUNTYAUOROR _ _
— �_
����•....
Dl'A\\'Cl" \0••..• e(monm.eaY.l'�d
C�l� �O• .....(� •��......•• 3ntisaresidentoflrMianaafM
�"1 i / �I
Date (rtanN. daY.