HomeMy WebLinkAboutMortgage_Brakebill"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
__ , FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fwm 43709 (R71 / 6-09)
` Presaibed M�P��rtl a( Local Govemmertl Firetce
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INSTRUCTIONS: ,,,ov aiN�t
To be filed in person or by mail with the CountyAuditor o� Counry Recorde� o/ the counry wl�ere tAe properfy is located. ��` Y L u��
Fil'mg Dates: i) Real Pmperty: Must file dunng the year (or which the deduction is soughL County AuEiwr
2) Mo6ile /Manufactured Homes not assessed as Real Property: Must file dunng the twelve (72) months C�J.
6efore March 37 of each year the deduclion is sought ry Remrdu
See reverse side !or addifional inshuctions a� qualfications.
t(owner.orconvaU buyer - see resvirbms m reve�se sitle]
m
— �--, _
1 rahie ti real qaprlty as of
aman yrar
his / her eYatl shara of interest?
If riame m tetotd's dAferent ihan Ihat al app6rant, uWiqte below:
Nanre of morc9a9ce or
or mntraa seller (nwr6ei�IW streeC
Ner owner or holder ot mOrlgage
(n�mber aM street ury. sfefe. eM ZIP caEe)
Does epplkant wm P�D�Y in any oNer
munry in IMara? � ..
n p , O D O.� S y— D O S R�� �� P�Br� S�O_
aa intlebtetl�ss unPaitl as of Mongage I ConVafl uWebtedness unV� as d Is ihe aPP�t 1he sde
yerr Cate o( aOP�� I�al w eWibde owneR
� DD ❑ Yes ❑ No
If owned wiN samearie aher tlwn spouse, indicate wiM wMm
ard ZIP oode)
IS tl�e 7�PeNY in Vuestian: Mnua�y Assessed
❑ Real ProPeKY ❑ %��Y �
MoWle Home (IC 6
What Tarirg DislricY? Has tha deduUion Eeen m9uesleE m 7�Y
far wrtent yeaR �__ �.