HomeMy WebLinkAboutMortgage_Fenwick""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
St�e Form 43709 (R8 / 2-07)
�' � Presaibed by DePenment of Laaf Go�emme(rt Finance
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FI M
INSTRUCT70NS:
To ba filed in person a by mad wrfh Me CourrtyAudifor W the counfy where Ne pioperty is bcated.
Fding Dates: 1 J Real Prope((y.� Durrng the f 2 mont/ts before June 11 d the year the deduction is to be e//eclive. Y. 3 ZQ�9
2J Mobi7e Homes assessed under IC 6-1.7-7: Befween January 15 end Ma�ch 2 0/ the year the deduction is to 6e e ��
See reverse side /a additional insbucfions aIM qualifications.
buyer - s�ostricfions m
as of March
his / har eraU share of iMeresl?
or
�
iber / legal descrfptiori /� (J Reoo P rwmber
' ' �� V S
� Y� �9a I Contraa indebtedness unpaid as M March t. Is Ne app6�ant Ihe sde tegal «eWllahle wmen
arteN year
❑Yes ❑No
If owned with someone dher Uan spouse, indicate xith whom.
Address of rtqr19a8ee a mniraG sellel (mm6er and streeC dtY. siate. srd LP code)
Name of assignee or oUier umer w hdder d mangage
Atldress d assi9rree (rumba and sLeef. d(Y• sfafe. and
oo� eva�a �, �rty �� �y ou,«
courayin Inaiana7
❑Yes ❑ No
Oeductlan appmved in the amwn� of:
� �_
SigraWre ot CounN Aud'dnr
de, - FE,t> l,��j
�F ��,�N �
_ Qu��; isF� AN y D
- �g,gs3
N1 � 2b
Is Ne praperty in Questim:
❑ Real Pivperty ❑ Modle Fbme QC G7.
fea�a;o� tee� �eyu��ea o� �ny
n y�n
❑Yes �No
20_ � 20_
(manfh. daY. Y��
20
I I We certify under the penalty of perjury Uiat the above and foregoing infortnation is true and mrreU and that the appGpnts was / were a residen[ of
Indana and owner of Ne atoremenfioned property March 1, 2p
e(9y-ni[s MI name) _ � Date (mmfh, day, Yeen
or
ndaress a au�ror¢ed pmsm (num6erand street cay, state, and
1
Dale (mon(h, day, Yea�