HomeMy WebLinkAboutMortgage_Stiles^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBT�EDNE:
FOR DEDUCTION FROM ASSESSED VALUATION.; :;
� �• State Fwm 43709 (R11 / 609) tit _�i ?l.='
S P PresaiEed by DePartment W Lo(al Govemment Firence
��� 6
File Mark
INSTRUCTIONS: F� �� �:
To be lled in person or by mail wifh the CountyAUditor or Counry Recorder o/ the county whem tg ted.
Fd'mg Dates: 1) Real Property: Must fi!e dunng fhe year Por which ffie deductlon is soughL `� � � County Auditor
2) Mo6Be / Manufactured Homes rpt assessed as Real Property: Must h7e dunng the twelve 12
6efore March 37 oteach year the deduction is saqht. G�gSON COUNT A ❑ Counry Recordu
See reve� (oradtlrtronal insWCfnons arrcl qual�tions.
n
�(o�mer _ bul'er - s restm^,noiu on�e rs� sile) �_ A.... � � _. I
�Y
�!z,tt,c,c�,.�c;cc• �� —,.l
Aaessed vdue d real puP�Y az of Mortpa9e / Cont
'a�U 7, aurent year Ma�ch 1, wrrent
n �o. wna� is nis � tmr Qua share or mtereu?
I( name on reco�d'a EiBemnt ihan tlut of appGrant, uMita[e below
Nameo(mortgageeorcmtraclse�er ,{ )/.
I\ /I/
UC-C.
Mdress of mon9agce or mntraa se�er (mimbrr and streeG city, s+ate. aM:
Name of assi�ee w oNrr ovmer or holdnl o( mvt9age
PLdmss of assignce (number aM atreeL �: stafi. and ZIP cotle)
Does apWicant ovm propulY in any oNg _�� s, what munl/1
counryinlndera? ❑ Yes r/
, �' 1 � � � A �
��3
S��
' a a��,� �
.��/ / / �/
_.., me penalry of pe ` ry Nat Ihe abo�
wntrad buyer of the aforementioned properry
iwne/s (W name) ��
o D ,�x�
[ aAtlress ot appGrani (wmber and sLec4 dty, sfate,
�-aao.a�-aos ����
Ic
ss unpaiE as of Mortgage I Contrx3 uMebtedness �spaid as ot
D� date of appGCation
H owned with somea�e other than sP�. iMrate witli wh
Is Ihe property in Questic
� Real Property ❑
� app6rant Me sde
or epuitable ovme/t
❑ Yes ❑ No
Assessed
Has Ihs dedutlion Eeen requested m propelty
forartentyeaR n ..__ fl �
�p 20 I 2l1 _ I 2� _
.�
^� I Counry I Date (monfh, eay. Yeah
regoing intortnaGOn is we and cortea afM ihat Me applinnt is a residertt of Indiaria aM
appiiration is filed.
Date (monfi. daY.Yae�)
utho(aeO by Euty executed Power of At[omey or by IC 61.1-12-0.7 I Date (monM. day, yea�
of auUror'¢ed per'.�ai (numbereM sLee4 dN. ��e, aM ZIP cade) _