HomeMy WebLinkAboutMortgage_Gonzales^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
__,_ FOR DEDUCTION FROM ASSESSED VALUATION
� �• Stata Fotm 43709 (R11 / 6-09)
�' P2saibetl M DePartmeM af Latal Govemmenl Fiiance
�1STRUCTIONS: �:
To be frled in person a 6y mail with Me CountyAuditor or Counry Recorder of the county where the property is loca�di R 2
Fitirg Dafes: i) Real Pmperty: Must file dunrg the year for which the deductlon is wughL Counry Audimr
2J Mobde / Manufactured Homes rat assessed as Real Property Musf fite dunng Me fwelve (72J months� �nry Recorder
be(ore March 31 of each year the deduction is srought.
r
Sae 2verse side (or addifional instruclions arnl qualifications. � r n � �
Appfxant (qrrrer u mn(raC 6uyer - see res`O'�c0onc m reverse side� � ��
d
�( Iq. W�18I 6 t115 ��IE! CSdG�
If'wrie on reconE s dMem
Name
mortgage¢ pr mntraq seder
ieps� ad
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a ol
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Yes LI No
¢s(? tl wmed wiN mmeor�e dher ihan spouse. iridimte wlth vArom
appfipnt, c�d'uate Debw. Is Me On+PenY in Vuestion: MnuaOy Assesse0
� PtopeflY Q M1b Il Fi� (IC 6
Name ol assignee or oNer avmer rn holEer ot rrortga9e
AOtlress of assi9nee (nurMerand saee4 �Y. �e, aM
Oces a�iont own pmperty in any aNu
munry m Ind"ana? ❑ Yes ❑ No
. ,� :
approved'v� the amount of.
[�r cace�
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auoROR
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D]. � �
a iti e!' 1\`0... h
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Car� iYO. .. ..,��� .. ..
, ` �{�,�55.��......
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20 20 20 _ 20 20 _ 20 _ 20 _
Sig�wre W Co�mry Auditor Counry Date (monN. daY• Y��
1/ We ceNfy under Ne penalry of perjury Nat Ne above and foregning infortnalion is true and correc[ and ihat the applinnt is a resident of IMiara aM
owner I contract buyer of the afaementioned properry on d application is filed.
� owrre(s tl �) � �� � � Date (mon7h. daY. Yaa�)
!A��/1. �
FWI resitlf ent ap�rant (n� ber antl sUce; �, state, IP eL� /i �� � �/� / / �
1 �..� ��-1 � C l.0 �Y
Pn�son authoraed Dy Cuy exeweed Power W Attomey or by IC 61.1-12-0.7 Date (rtanN, day, year)
AEtlmss of au4rortred pe�"..on (number antl sbee; cdy. state, aM ZIP mde) .