HomeMy WebLinkAboutMortgage_Heldt^'+ STATEMENT OF MORTCaAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
:,_—
FOR DEDUCTION FROM ASSESSED VALUATION
• Stale Fortn 43709 (Rtt /6-09)
S� d p�y� y�, cePy�M of Loral Govemmenl Fnatxe
File Mark
�STRUCTlONS:
To 6e filed in person w by mail wifh the Co�nryAUditor or Counry Recorder ol the county where the property is located. F
Fi!'mg Dates: 1) Real P�operty Must file during the year for which the deducUon is soughL ��
2J Mo6�7e /Manufactured Homes raf assessed as Real Property Must file dunng the fweNe (12J monNs �
befae March 31 of each year fhe deduction is sought. ❑ ��� ��
See reverse side foraddrtionel insVUCtions and qualifications. GI
Ta ' D' ' -Key bv / al tlesviption Remrd rwmbel Page number
_ a�- - - O/ ��- �� o?o // 3 3/
0.1sessed vaWe af reai as d M�a g / ContraC'udebtedfcess unpaid az W Mortgage I Contrxt'vNebtedness unpaid as d h Me app&ant Ne =^b
Marti� 1, am�nt year MMart� 1 ewrrent year date of appfi�tion �(` legal or equ0ade oxmM
a�� .��UIJ ❑ Yes ❑ No
If m, what's his / her era�l share
�
Name of mortc�agee or mnttad seller
Address of mortgagce or conbact se0er (number eM street,
Name of assignee or oNer owner or hoWer of rrortgage
AECress ot azsg�ree (number aM street clry, s+ate, aM
tinM o+m property in any oNM
InEana?
❑ Yes
oee� aaa�a m u� ���
i� I �°
arM
I If yes. wfiat count7/�
No
�o�
� zo
tt ow�ee wiM sorn�wne oCcer inan
uNicata with wMm
Is 7�GertY in VuesOOn: MwaM Assessed
RealPmPeKY ❑�!�!!�J�
n property
�Q11....... ❑ No
Dra�vCr NO.....
5 331
Card NO . .....................
�j�6 � b� . 6�
I/ We certify urWer the penalry of perjury that the ahove and toregoing infortnation is We and cortect and that Ne applirant is a resident of Indiana aM
owner / cantracl buyer of the aforementioPed property on date appliration is filed.
In?tqre �ownehhN name) �. . /i . � Dare (rtmN. daY. Y�a�)
�I (numDe� aM SfR¢t, Gty, slate, anO ZIP m
N l�/�LE//1�'.CS:.'D �/L� �i7lo
y exewteC Power of AI[ameY a�' IC 61. t-12-0.7
Address of authoraed person (numbereM Shee4 city. slale.
Date (monN, daY, yaaA