HomeMy WebLinkAboutMortgage_Deffendall^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co Township vear
_ FOR DEDUCTION FROM ASSESSED VALUATION ��
� State Fwm 43709 (R11 / 6-09)
�' P�ewibed by DepartmeM of LaW GovemmeN Fu�arce
"" File Mark
wsrRUCnoNS: I'I Z012
To 6e (led in person or by mail with Ne CounryAuditor or Counry Recorder of the counry wM1ere the �JriSpNe� is located. F� �� ��
Filing Dates: 1) Real PmpeRy: Must �le durirg the year /or which the deduction is soughf. n��q� � Counry Auditor
2) Mo6de / Manufactured Homes rrot assessed as Real Property: Must file dunng the �'weh�7 �i th
befwa March 37 of each year fhe deducUon is soughG County Recorder
See reverse side for additional instmctions and quali�cafions. gSON COUNTY AUDIT R
l�ppGranlJpwner orcontract buyrer re¢�resvirli�(ns m reverse ��
Alald� 7. amerLL Y�r
Ii ro, what a his! her e�
If name m Rmtd "s ddfe�a
Key numlfAl legal desmDtion
'.� � _— �:-� — � Q —
app6rant, uiEicate belwr.
rame N rrort9a9ee or wnbact utler �/�
AGdress oi �rort9a9ce or mntraC seller (nwnbe�end stroe; cifY. state.
Name ot assignee or other oxner or hdder of mort9age
AAdress ot assi9nee (number arM sbee4 tlry, slate, aM Z/P oode)
Oces applimnt own poperty in any oNU If yes. what a
muntv in 1nd�aria? � Yes ❑ No
at
"000 • G
wss unpaid a ot
If owne0 wiM mmearre
��"
Remrti number Page numbel
�
pt�W�e�s unpaitl as of Is ihe epp6[�nt Me sok
iegal w epudade rnmel7
❑ Yes ❑ No
spouse. md�te witli whom
IS M2 P�PQrtY Ifl QIIPSb011: MfIWOY i1S5255Ed
�� �� � ��� . . .
NTatTa�drgDistrict pE�'tr`-' N�� •,O�Yh'
GOUNTYAUDROR I �' ����
Zp 20 _ 20 20 _ 20 20 _ 20 _
Sigrenrte ot Co�mry Auditur ' Counry Date (rtrnth, daY• Y��l
I/ We certify urWer the penatry of perjury tliat ihe above and (oregoing infortnalirn is W e and wrtect arid that the applinnt is a resident of i�iana aM
owner I contra�t buyer of the afo(ementioned property on date applicatlon is filed.
Sign�ure (ovmefs /ull neme) . Date (monfh. day, yrea�
Full r�l=ent address ol appCrant (lbm�er antl sLeet, riry, state, aM nf� m
� 5 1 �° W C�-�+�-L--r' 1�1� •
�uson au0ro�rzetl Dy O�dy execu4d Power ol AttorneY or by IC 61.1-12-0.7
Pddress of author'¢ed person (num6er arrtl sbeet �+�Y. ��e, and ZIP mde)
Date (month, day,