HomeMy WebLinkAboutMortgage_Fischer (5)ti� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
___ ,� FOR DEDUCTION FROM ASSESSED VALUATION
� • State Fortn 43709 (R71 / 6-W)
�' w�. t Presaibed by DeGa��M of Local Govemrtrent Fnance
g File Mark
�STRUCTIONS: 9q
To 6e filed in person w by mail with the CountyAUdRO� or Counry Recorder of the coun e�hNp�'d� F0`m �� �'
Fil'mg Dates: i) Real Pmperty Must file dunng the year /or which !he deducfion is soughL County Auditor
2) Mo6ife /Manufadured Homes rrot assessed as Real Property Must fife du ' �t ¢nve (12)4�onths
before March 310/ each year Ne Ceduction is sayht. �' '` J�: !�:! Counry Recorder
See reverse side,Jet additional instructions
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poperty Mortnage / Contract irdrbtedness u�Pab as d
Mamh 7, arren�� O O�
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Ii name on record "6 AiRerent Nan Nat of appfrant. c�tliCate hebw
Name or mortgagee or cmvau selier
nddress W nnrtgagee «canvact seoer (num6er and snee(, cdy, sfam,
I;cr"
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mortgage
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��9a9e / ContraY
date of appGretion
H owrred vriN someone other than spause. iMicate with wham
s, what munty7 I Whal Tadrg Disirict?
COUNTYAUDROR
_ 20 _ 20 _
c«��ry . �,
Page�ryqpr,�
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�itaNe or+ieR
Yes ❑ No
Is tl�e 7�PertY in VuesOm: MnuaDy Assesse0
❑ Rea� aroxm' ❑ aawa�y ws�ed
Has Ua deduction been requested m propGty
tor cu�ren� Year' r—i .. r-� .
r.���
oate (rt�. eaY•Y��
20 _
I/ We cert'rfy under the penalry of "ury that Ne a aM foregoing infortnation �s We and corteci and that the applirant is a resident of Indiaria ard
owner I contraG buyer of Ne aforementioned prope n date applicalion is filed.
��Y//--f /J�YC;Q,'-!C� oa� (r�or:n. OsY. Yea�
II resiEeni atldress of appOCant (number anC sLeet, rity; slate, aM ZIP oode)
f � , ' �6�J
rson au by OWy execvted Pawer ofMtm�ey rn by IC 67.7-12-0.7 Date (mmN, day, yea�
dress o1 authorrsed prsson (number aM stree; dry, slate, erM ZIP aode) _
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