HomeMy WebLinkAboutMortgage_BattramSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
FOR DEDUCTION FROM ASSESSED VALUATION �� ��
Stata Form 43709 (R70 /11-08)
` = Presaibed by DeparMent d Loral GovernmeM Fcan�
INSTRUCTIONS: Fil nM��prk�� -
To be filed in person a by mad witlr the Cav�yAuditar d the oounty where the poperty is facated. .J U N 5 � V V J
F7irg Dates: 1J Real Property: Musf 61e during the year for which fhe dedudion is sought.
2) Mobde /Manulactuied Homes not assessetl as Reel PropeRy: Must file tlunng tlie AveNe (72J mm(hs 6e/ore M� 310/ each year
the dedueLbn is suught �: µ�� =�
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See reverse sitlA1M edd6ional insWclioi�s aM aualific%ilens ./ �._.. .....,r.,o
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A4tGi 1. anrertl yea
Y ro, whal is ha I her axad
C�ma on reard is dINerar
Nanre d mofigagee ar mmracl se0er �/ l
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Nddrass d rtnrtBapee v corrtract sa�er (nmbe`and 9reeC �: sbfe. and ZIP code)
Name d assiB� or Wher w.+�er or tdder of moM19aBa
oms app�wn� w.,, popenr � ary ahar
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❑ Yes ❑ No
oed�aion awrwee in ma amouM d:
20 20
ra trty AuL'dw
I/ We � untl t e penalty of G
owner / mntrad r of Ne afo tior
� Y�.
n
RecorE n�
E
unpaiE as d Is Ihe appficzN Qre stle
I date ol apptitaliwi I legal n eQUitable wvneR
❑ Yes ❑ No
rc w.+iea vNn wmeo�re dner uw, saa�. iMicale wim wom
I5 ma woveM � aueslion: am�vvy nssessed
❑ReaIP`opeAy ❑MnualyASSessed
Mohle Hort�e (IC 6
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�he above and foregang m ation is We and corred and that �he appliwnt is a resiaent of Indiana and
property on tlate application is filed. �
�s222��F .Z('''-�S�Of1��ii.✓d G�
Persm aulhaaeE by duly e�ted Power dAnomey w by IC 6-1.1-12-0.� .
AdErass d aNhorize0 person (number arN s4cef, city, ffite, antl LP rntle)