HomeMy WebLinkAboutMortgage_Heacock (3)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C own ' ear
? FOR DEDUCTION FROM ASSESSED VALUATION �,
� Sbta Fortn 43709 (R71 / 6-09)
� Presaibed by Department W Lool Govemment Frence
File Mark
INSTRUCTIONS: 4
orm mee vritn:
To be filed in person a by mail wiN the CountyAuditor or Counry Recorder o( the county where the properry is located.
F7ing Dates: i) Real Property: Must file during the year for which the deduction is soughG �} �upry quditor
2J Mo6ile / Manufactured Homes rrot assessed as Real Property: Must file dunng tAe lweNe (72) months /jM
befwa Ma�ch 31 0/ Bach year the deduction is sroughf. � Cour� Recorder
GIBS . "
See reve e side tor adUilional insVUCUons and qualficafions. "'
ownerarcontraGbuyer-see ,. . � rg e�
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n0. w1aI6 N51 Mf C`2G
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- -�- 3o a-000. 3 a� -o0 7 �009 ss8-s
Mortgage / Convaa In0e6�etlness unpaid as of Mortgage I Conaad iridebtedness unpai0 as d Is ihe applimnt the sde
Mart� 1, artent year Oate oi appGption legal a epuitable awne(.�
�� � � ❑ Yes ❑ No
If ovmed wiN someone dher ihan spouse. ifdkate Mith wMm
��
Name of �ee or mntraU seAer / F,L j , % W,1`
n � M `ti��
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Address W martgagee or contraG se0er (number and sbee; tdy, slate. aM LP code
Name of assignee w othei ovmer or hdder of nwrtgage
Adarcss of assignee (number en0 stree; dry, state, and Z/P code)
Does eppli�anl wm pmpercy in any oNer If yes, what munty+
oo�(uy i� ��amruz
❑ Yes ❑ No
�o�
Dr�uctim epproved in Ihe amount of:
20 20 _ 20 _ 20
i -. _. �
I I We ceNfy un er the penatty of
ownQr I contract buyer of Ne afon
What Tadrg Distria7
20
l�pfOpffly III QINSOOfI: (VIIIU3q' i�S5C55G�
Real PmPeKY ❑ �^�Y�
�1'�{5'CI'1�`�....��09 �
Card i\'O. ... S5�
� �{�1, 34u. a� . .. .. . ..
20
Oate (nmfh. daY• Y��
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that the above arW foregoing infwmation is W e and mrteG aM that the appGrant is a residenl o( I�iana arM
ned property on date appliratlon is filed.
arN stree4 �; �te. antl Z1P code)
Person authar�d Dy Euh/ executetl Power o(AUwney w Ey IC 61.1-12-0.]
AdtlreSS of aNhorrzed persw� (numbereM 5beat, rily, sfate, aM ZIP code)
60
Date (monfh, Cay,