HomeMy WebLinkAboutMortgage_Davis (27)"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_. ; FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fwm 43709 (R17 / 609) ,
`,�,. ProSaibeO EY �nl a( Local Govemrne�LL Firence
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wsrnucnoNS:
k be fiied in person w by mail wiM the Couny Auditor or Counry Recorder of the counry where the property is located. � j j ��Q
FrNng Dates: i) Real Pmperty: Must file during the yrear for which the deduction is soughG L�ounty Auditor
2) Mo6de /Manufectured Fbmes rrot assessed as Real PropeRy Must h7e dunng the fweHe (12) months ❑
6efore March 37 of each year the deduclion is sought. Caun , Recorder
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See reverse side (or additional instructnons and qual�cations. Q
eypGtant(owr�eru�contraebuyerysA�resnictioasanreverseside) --�- • � Y P.UDITOR
Xssessed vdue d real PmpertY as d
Mmrh 1. anrlrt yrar
If ro. whal Is lus I her uafl share Of inteJesl?
tl reme m remftl ia ddterent than Nat
rlan�re or mwtgayee «
/ iegal deso'rytion
- 3 -/
AO2q0Ae / ContraQ
mntraa se0er (numbel end stree4 �l:
Name ot assignee or oNer owner
MEress of assignee (number en0 sneet �Y, sfe(e.
�G (� i
az N Mwtgape / Cmtraa'u�EeMedness unpai0 as d Is Ne appOrant tlx sole
date of aPP�tbn legal or eWita6le ox+�M
n Yes ❑ No
Oces applirent wn yoperty in any oNer I R yes. what munryR I WN
munrymlMiana?., (� Yes1 ❑ No
am� appo�ed b Mce amouH af: — .
Zp 2p 20 20
mmeane ather ihan sGa+�. mdKafe WN whom
in QursGan: MnuaDy Assesv.W
�r ❑��'i�
e�oe�� rw�,e nc ��.
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]�l':1\\'CI' \�... `�?lT'
C81'(1 \O. ......�• I�......
�1 '��cc� ��``,�'�� �.��
20 20
� P�Y
20 _
SignaMeWCambAUditor \� ;� ._----_--. CWnry Datei�.daY.Y�A
� 1 I We certify uMer the penatty of perj�ry Nat the aDOVe and foregoing infortnation is We and correct and that the aFP��mn[ is a resident of IrMiana antl
- owner 1 mntract buyer of Ne aforemen0oned property on date application is filed.
Sioriasue (oxneh fW namel . Date (nnnN, daY. Y��
Cnnt aedras W appfrant ( rantl strea4 m76 ��e, and nr m
oa w rv�ui�n �Po � 51 � �ra�
auNOrved Dy dWy exewtetl Power W Attomey rn Oy IC 61.7-12-0.7
� of aWw�'ved persd+ (number aM streef, dry, sfate, an0 LP code)
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