HomeMy WebLinkAboutMortgage_McClure"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co ear
_.. FOR DEDUCTION FROM ASSESSED VALUATION
. � Sfate Fortn 43709 (R11 / 8-W )
`,,,. P25�snbatl trl �N+��H of Lxal GovemmeN Finarr.e
INSTRUCTIONS: - O��I • *�UI
Farm filed wMh:
To 6e fiied in person w 6y mail with the CountyAUdilor or Counry Recorder o/ fhe county where the properry is bcated.
FrHrg Dates: 7J Real Property: Must file durirg the year for whirh Me deduclion is soughL �ouatY quditor
2) Mo6Ae / ManufeGu2d Homes rrot assessed as Real P�ope Must file dunng tAehyeNe (12) rtanths N/`
6e(ae March 31 of axh yenr Me ded�tion is soughG �%'j ` Co� Recordu
I GI°$O� ri i-v ,
See reverse side Jor additional insfrvUions and 9ualificahons. � �v�� �- Z�e� � ..
Apq'qm1�T�/oroontrarl6N�r-seeresbre"orumrevm5f�) �_
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�T �istrid Key nmDer / le9al desmption
/�o�cc;daa � 6�� 3_ o_� 01 - o o a � 0 5- o o S
Ar,�aM vahe dmai P�D�Y as d Morf�a 9e / CantraU irde6ted�ress unpaid as W Mongega I ContreU intleM
Mazrh 1. pr�crt year Mard� 1. artmt year Cate of app6mton
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I(110. Wh3[ 6 h151 hPl BY2G 5112R 01 V11BRSf%
It iurtre m remtd a dtlferent Nan
Nartie N nattga9m or contran se9er l
S
shaet, ury, smte. aM LP code)
Name W assiqnnee or Wws wmer or hddar M mar4)age
AdE2ss of assignea (numbar arM saee4 �Y. stere. an0
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Does ePpfitant o.vn pmperty in any ot�c
county in Ind'ana? ❑ Yes ❑ No
o���, aow� m me �,�u or.
zo _ zo _
� �
���a���, �
I/ We certHy urdv penatry af perjury Nat
owner I contrad buY� of Ihe aforemerrooned p
sqnamre (m.nerS Na name) � .
aWaiaed �y d�9y
AdEress of aWUf've0 person
N cv c� ao - a- 9
If yes. what mum�l What Ta�dtg D'ahiti7
couNn nuoROa
zo _ sa _ x
�
e a6ove aM toregoing infortnatirn is we and a
rooerty on date aDW��n is filed.
iM street d�: stam. antl LP cade) •
�rn�.' , � �, � . � .r�r, �.x�
or nwmer «cy ic s-�. i-i z-0.�
' aDee; ciry, state, aM LP mde)
I�al «equimde o�wft
❑ Yes ❑ No
spouse. indicafe with whom
�5 �1C pfOPGf� Ifl QUESf1011: iV11W'd�`/ i145C55Cd
� Real RoGeKY ❑ ?n!�!�Y�
,30 �4�
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Ca�d,�• .... .• dp/
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_,a�n �s a resident o! Indiana aM
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