HomeMy WebLinkAboutMortgage_McClanahan"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_, FOR DEDUCTION FROM ASSESSED VALUATION
� _ Sfate Fortn 43709 (R71 / 6-09)
�' ,.,. Presaibed by DepartmerLL o1 Lo�l Goremrtrent Frerca
INSTRUCTIONS:
To be fiied in persnn a by mail wdh the CounryAud'ROr or Counry RecoNer of Me counry where the property is located.
Filirg Dates: 1) Real Pmperty: Must file dunng Ne }rear /or which the deductlar is sought
2) Mo6de /Manu/actured Homes not astessed as Reel Property Must file dunng the tweHe (12J mon s
6efore March 37 of each year e deduclion is sought.
See reverse side fnr additional instruclions an �%j�
f rw byer s�ee �
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Name oi mortgaJee «mno-aa seuu
Addres of rturt�a9ee ar mntrscl se0er
Name o1 assignee w dha ovmer w hd
ooes a�m avn wocenv in afry omer
m�my � mae�,a? ❑ ves
Ihe amount
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6Wit2te bedo�r.
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�9a9e
slate. aM LP cM^� -
If yes,
I r,o Dra�ver NO....,�.�,.�. `v......
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✓
Q ���CaunryAuditor
❑ Counry Remrder
kpal or epuitade wmrYl
❑ Yes ❑ No
wouse. inditate wtlh wtom
Is Ne P�GenY in 9ueslion: MrniaOy Assessed
� Real P(oPenY ❑ ?!?i!m�y� . _ _
ste0 m P�Y
Yes ❑ No
`2� �_ �_ tn � _ �_ �
I
�natura U CamN nueimr Counry Date (monN. daY. Y��
I/ We certify under the penalry of perjury that the above arW toregoing infwmalion is We and cortecl and that the applipnt is a resident of InEiana aM
owner f mntract buyer of the aforementioned property on date appli tion is filed. -"" "
i�alwe (o hArem� � iJ /_ trafe (monN. EaY Y�)
t(appGfant (numbor and 5Lee4 rnY, s�te. a ZIP oode)
' i F_ as s , � �,K,
iWyezewtedPOwerofAnomcy IC61.7-12-0.�
person (numher and sneol, ciry, stale. end ZIP cotle)
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