HomeMy WebLinkAboutMortgage_ShoultzSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_ FOR DEDUCTION FROM ASSESSED VALUATION
Stala Fwm 43709 (R71 / 6-09) '
� Presvibed by DepartmeM o1loW GovemmerC Fitwce
ark
INS7RUCTIONS: c �� �
To 6e filed in person or by mail with the CountyAWitor or Counry Reco�der o/ Ne counry where the property i.�'�tap. 2
Filirg Dates: i) Real Pmperty: Must file dunng the year /or which the detluction is soughL Counry Aud'ROr
2) Mo6de / Manu/actured Homes rat assessed as Real Pioperty Mus! fJe during Me hveNe (1 �, , �unty Recorder
/� 6efore Ma�ch 37 oleach year the deduclion is sought �
See rev(rse� side 7or adyilional in�r ctbns end 4yAlificayons. r_i nen.� nn� �.�r.. .��.,,�....
lisbi Keynumba/legaldesaiption ^� /.)�'� /—' OD _,^�. @Fmld _mber_ PaBewmbrl
�z �..� �.J d-C�O y
d value af real pioprny of Mortga9e / Cantract irde6tedness unpaid as d Mortgage / ConSatl iMebteOness �mpa'r1 as d Is Me app�wit the sde
, p�¢ y� Mamh 1. W rtent year M Oate of aPP�kation �egal or epuit2de owneY/
7 W� ❑ Yes ❑ No
a� k his / her eYar� share ot inte25t? Ii awned with someotro dher Ihan spouse. iMrcate with whom
on 2mN is dAterent Nan Ihat of app�cant, uidica[e bebw. Is Me pioperty in puestion: MnueAy Assrssed
� Real Ploperly ❑ Armua�lyA�sessed . . _
Name of mort9a9ee «
nedress m rtnrtgagee or mnaaa
awnet a hdder W mortgage
ury, 4fa�, arW LP code)
Mtlress of assi�ae (numOer eM slree4 �Nt swe, aM ZIP ootle)
ppes aPp�iont pm poperty in any afher If yes. wtk
mun[ymlbafa? ❑ Yes ❑ No
Dedudion
I
Psson
20
of t�e
�
-.� l l o G(. � TZ D��D �
sir' Du-L 1 Z� �'�
� aoir- 9�3
20 � 20
Counry
20
Deen re9uested on P�Y
20
the above arW roregoing intwmation is trve and mrtect ard that Me applirant is a resident of I�iana aM
roperty on date application is filed.
n n . � Date (month. daY•YaaA
Powe1 af Attrmey or by IC 61.742-0.7
person (number aritl sbee4 �y. sbte.
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7/4g
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