HomeMy WebLinkAboutMortgage_Foster"•* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C Tow ear
:_ : FOR DEDUCTION FROM ASSESSED VALUATION
� State Form 43709 (R71 / 6-09)
�' 1 PresrnbeC bY �Pa��nt of l.ocal GovemrtreM Finarxa
File M rk
wsrRUCnoNS:
I II
Fartn ed wtrh:
To 6e filed in person or by mail wi[h the CountyAuditor or Counry Recorder o( the county where the pmperly is loca(ed.
Filirtg Dafes: 7) Real Pmperty Musf file dunng the year (or which the deduction is soughL � r,p�y p,�di�p�
2) Mo6Be / Manufactured Homes rwt assessed as Real Properry: Mus! fde durirg the tweNe (72) months s� �U /��^
before March 31 0/ each year the deduUion is sought. �} Couo�Remrder
See reverse side for add'Riona/ instructions and qualilrcafions. .�
GIBS R
I Appf�nt (ownerar confrdrt buyer re5nrb'w�s m�rse side) �
ber / legal dvsaiption Recoid wmbnl Page number
-ly-! -ao3-DoD.�ss_oo�
Abrtgage / Contraa 4debteCnrss unpaid as of Mongage / Cantrarl iMeMedness unpaid as d Is Ne eppf�nt the sole
Mart�h 1, turtent Oate of appfitation legal w equRade ownM
�-i� n n o n Yes ❑ No
6 h6l h¢! ¢I3G Sh2f8 Of II11Cf¢51?
H name m�ecw0 is dRUmt than that of aPP��t hM'uate Debw:
Name ot mortgagee or mnvaU u0er
cantraa sWer
^ S .
hr! stree4 ��i: stare. aM ZIF
nprtgage
state. ard LP cade)
dimnt ovm pmperty in any ot�er I If yes, what muntyt
Inaana? ❑ Yes
❑ No
If awned wiN mmeane other than spouse.
IS CIC W�PQrtY N QUC51M: Mf1118II)' ASSCSYb
❑ Real ProPertY ❑ Nmualh� Pssessed
M1bWle Fiome (IC 6
s Nis deduclion Oeen requested on Omperiy
arrent yeaR ❑ Yes ❑
COUNTY AUDITOR
De�utlion aPP�� in tlie amouN aE j .
%
�%�/ �P�% ��C%5/�5 /'��
20 _ 20 _ 20
' � O 5 f-� i'` � �°'-�I
sg�awa a can,n nw�mr
I/ We certify under ihe penalty of perjury that Ne above and k�� I W s s�2 ��K
owner / mntract buyer of the atoreme " ed property on da[e �(,� �()�7
� � Ginn�Tisl /nwwh RM rumnl �. _ _ / • . , . � �dG
Person
W
Isi �
person (numberaM sbeef, cily, SIaIB.
_ 20
(rtwnth. daY• YzaA
3nt is a resident of I�iana arW
'. �RI(Nii. dd' y jB8/�
� (mmN, daY. Yaa�)