HomeMy WebLinkAboutMortgage_Singleton^'n STATEMENT OF MORTGAGE OR C�� IN��D IESS Coun Township Year
= FOR DEDUCTION FROM ASSESS V. UATd 1.!
• $tale Fortn 43709 (R17 /6�09)
S PresviDetl by �epart�rent o1 Loral Govemmenl F�ance MAY 10 2012
File Mark
STRUCTIONS:
C .'J Form Aee wim:
To 6e (led in person w by mail wifh the CountyAuditor or Counry Recortier o/ the efe tAe pmperty is located.
Filirg Dates: 7� Real Property Must fi!e dunng the year lor which tha deduction is s IN� � Counry Auditor
2) Mobile / Manufacfured Homes not assessed as ���A���l��� fwefve (72) monfhs
6efore Ma�ch 31 of each year the deduction is sought " County Recorder
See 2verse side for�ditional ins[ruclions and qualilcatrons. � '�
Ass�eO vahre dmal P�O�Y �
MalUi 1. aYmla ym
It no. what Ls his! Mr emct share
11 name m remd's diRernn[ Na�
�y
Name of rnortgapee a conVact se0er
AdCress of rtart9a9ce or contract sWer (numb
�-aoo -ooY.a.�9-o0 �
'udeEtetliress unpaid as W Mort9?9e / ConvaC ude'.
cdy, state. aM
Name of assignee or mhe� ow�er or halder of mon9age
Address o( assgnee (num6er aM streek �: �e, an0 ZIP mtle)
Ooes app�i�ant own yoperty in any other I! yes, wh:
munry m ind'ana? ❑ Yes ❑ No
COUNTY
approved in the amount of.
ez��
20
SignaWreol �ry^AyOi r
A\
I I We certiFy under Ne penalty of peryury � t Ne above and
owner I contract buyer oi the aforementioned property on da
Signanve (ownerE fid "�9e) �
FW% enaptlr¢ssWappfcant(rwmberantlshce4�4:�te.and/L�Pmda)
� 1�l �� � L/00 � /iR,FLWNdC G..�
Pefson authwrzed Dy tluy ezecuted Porer o( Attomey rn by IC 61.1-72-0.7
fbtlress of aulhor'¢ed De� (numbe�aM sLael, fily. sbfe, and ZlPmde)
What Tari�g D'strial
Page
..- \ ' IlegalareWitaWeovmell
❑ Yes ❑ No
�Pouse. ifdicate witli Mnm _
IS tlie V�VenY in Questim: MmiaOylvsSeSSed
] Reai a�oaertr � rw,�y wssessed
nlodle riorne nc 6L�-1
�9 S 54
Has Nis deduction been 29uested m property
tor wrtent yeaR ❑ YPS ❑
20 20 20 _ 20 _
��ry Date (monN, day, yea�
ig informalion is We and corteU arW that the applirant is a residen[ of Indiana ard
ation is filed.
Date (monfh. daY. Y��)
Date Grmm. Cfi: Y��1
� •I