HomeMy WebLinkAboutMortgage_Adams^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
•. —..
; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fwm 43709 (R71 / 6-09)
�' l PresaiOeC by Oepartmen� of Loral CcvemmeM Frence
File Mark
INSTRUCTIONS:
To be filed in person w by mail with the CounryAUdito� or Counry Recorder o! fhe counry where the property is located. F� .
Filirg Dates: 7) Real Property: Must file dunng the year for which the deduction is sought. ��� ��
2J Mobde / Manufactu2d Homes not assessed as Real Property Must file dunng fhe hveNe (12) months \
befae Maich 3f o( each year the deduclion is sought ❑ Coun r
See reverse side 7w addiUOnal inshuctions arM qualificatbns. �
App6cpnt (opner or wnvaa buye�- $ee re�iclions m re�xrse side)_ _ . ' �(� _ �
uun9 is � � Key number / legal descriDtion Recontl Pa9e num6er
- y- g-3oa - - 0�`7 � � 3
sesed vaAm d mal papef.y as of M�t�a ge / Contracc udebtedr�s unPaid as W Mort929e / Con�aU eWebieOness impai0 as of Is Ihe aP�� Ihe sde
ard� 7. cvrenc rear Mamh 1, a,rre�c au
yPar date of appGntion legal w rnmeR
s ❑ No
no, whal is his I her eratl share of interest? It ovmed wiN sameone other Ihan spouse. Indkate witli whom
name m �ecoN's Eilferent than that of aPW���. �irate Eebw: tl�¢ pppeny in puestion: MnuaDy Assessed
_ ,�„i r`—'_.-- �
�—'— •a� � ;
or contrxl seller
nartgagee or contract se�er (number and streeR Uy. srate, ard ZIP wde)
Name o( azsignee w other owner or twlder ot morigage
ciry, sle(e,
t��1�.........
Dra��•cr \0.........
���K� .......
Card \O. .. •
� ��.�
Does eppli�m o«n property in any oNer If yes, what wunry? Nrtat Taarg DisVict? Mas Nc deEWion Eeen requ te0 m pioperty
munry in InOiana? � br wrteN yeaY.+
❑ Yes �'NO Yes ❑ No
GOUNTYAUDROR
Dr�uUion appioved in the amount of:
20 _ 20 20 20 _ 20 20 _ 20 _
Signature d Counry Autlttw Counry Date (monf�. daY, yea�
I/ We certify uMer the penalry of perjury that Ne above arW foregoing in(ortnation is We and cortect and that Ne appiipnt is a resident of Indiana aM
owner / contrad e aforeme " ed property on date aDP��qon is filetl.
SigreW ow,rer's fiA me) Date (monN. day,Yea�
G-+..-t/2-
�en� o a t(numDer sveet ri1y. e antl e) (\ ���� �
3 � o�•
auNO�aed Dy d�dy ezecucetl Power of AtlameY a M IC 61.1-12-0.7 Oate (monN. tlay, yra�
Address o( a�thwrsed person (number aM sbeot. tlfy. sfale. an0 LP mtle) .