HomeMy WebLinkAboutMortgage_Stephens (3)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ . FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R71 / 6-W ) '?�" -� "',r �
,' „r Presmbetl 7y �epartr'cN a( Lxal GovemmeM Fuwce � �. •
�' FT�Medc�
wsrRUCnoNS:
Form
To be filed in permn w by mail with the CountyAuditor or Counry Recorder o/ the courtry where the popeRy is located. ��� Q
Fdhg Dates: i) Real Property Must fJe tlunng Ne year for which the deduction is sought. Cou�ry quditnr
2) Mo6Be / Manufactured Homes not assessed az Real Prt�peAy Must file dunng Me M1veHe (72) rtanths
6efae Mardt 31 0! each year the deduction is sought. � "tY
See 2verse side for additional instruclions and qualilcations. � TQf
MO���(°w^RS.crwntraCbuyer^uamsnictpqsmraversesiie) . n _ �_ . GIBBO
A�sed rAUe � mal p�operty a af
Alarcti 7, al'ent ye2r
I( M� W1f3[ IS hi5 ( hEf CYBC ShefB O� VIiPlEYi
If name on 2mN is dilfrmrt Nan ihat al appOCant, hMkate Eebw:
tJame M matBagea or
andsbeet
owner rn halder af mortgage
ot asse)nee (number anC streat tlry, sfele,
ooes epdicam oun wooe+h � s�y omer
munry in Intlanal r-� ..
u�"T;.�:-1
ns un0� as W I Cantrarl'uMebtedress unDaN as d Is Ihe aOP�� tlro sale
date of appOtation � a ePdtabk aw�ren
C ❑ Yes ❑ No
H owned with saneane otfrer ihan sPa+�. uWkate wirt� whom
�5 C1G (#p�E(ty 1!1 G�C�1 �OOn: MIIUBP� A45CSSCd
e91 PIOPe�f' ❑ A"^��Y � _
eM LP code)
� 7 �' � COUNTY AI
20 _ I zo I zo _ � zo
Dra�ver NO.. a�.�.�.......
c:,��� .�o. .....`�y.��..�.....
� � �� 3��- �
� 1 � � �V�
Sigrenue d Camb Nd"rtur .-..\�\il Counry Date (rranC�, eaY• Y��
J
� t/ We certify under the penatty of perjury that the above ard foregoing infortnalion is true end cortect and that ihe applipnt is a resident of InGiana aM
owner 1 mntract buyer of Ne aforeme�onea property wi date appliration is fiied.
� �p�R ry�p � Dale (month. deY.Yae�1
Fu0 rgident o( a t(numDe� aM street �% slate, eM LP mtle)
9is E s o s kl �e� C�� Z� `��660
Pasm aW�d Oy Mdy execute0 Power of AlmmeY a M IC 61.1-12-0.7 Date (monfh. dal: Y��
Gr�sm (numberarN sbee4 �: sbte. aM LP code)