HomeMy WebLinkAboutMortgage_Maikranzn STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ship
_. FOR DEDUCTION FROM ASSESSED VALUATION
Stata Form 43709 (Rii / 6-09) .
�,.,. Presbibed by DeG�� o( La21 Go'/emrtrerLL Ffrence
wsrRUCnoNS: ����` 7 2010
b be filed in person w by maii with fhe County Auditor or County Remrder of the county where fhe property is located. F� �� ��
FiNrg Da[es: 1) Real Property: Must h7e durng the year far whirh tha detluction is soughL � �p�,r(�d�
2) Mobi7e / Manulactuled Fbmes not assessed as Real Property: Must file dunng the IweNe (12J mon[hs
before March 37 o/each year Me deduction is mught G�B D�Counry�er
L�UNTY
See reverse si0e for additionaf inshucUons aM qualifications.
MP�nt (owxr or oonfraC b - see rasflirbons m re ffie)
4
Tatirg ' Key nunber d Remrd num0er Pape rvun6Pi
�� � 1 �.
A�essetl raWe d mal qopMy es of Mortpage I Contraa 4de6teCness unpaid az d Morigage I Contrarl uWe ess unpald az d Is Ihe appfxant ihe sde
MmU 1. amnt yrar M�rh 1 airtent yPar Eate a( aPP� � a eWitade ovmeR
❑ No
tl ro. what is his / her exad share ot interest? If owned wiN mien�e aUm tlan spouse. itWkate with wtom
If n,vme m RcON o Wftetenl Ihan thal O/ app0pnt. hWipte bebw: propeM1y in Quesfion: MnuaDy A45e55etl
' eal Propenv ❑ Mnua�yPSe�ed
0.UW1eFlome CS7.7-
Name ot mmgagee « mntract sNler . .�
Pddress rtiutgagce v contraa se� (num_ ne s LI ,� .
. �i i,1'`1
Name ot assgnee w W�er mmer w halder of mvig C O '
a'•v�� ...aa ��
P4Cress of asvgnea (number arcl stlee4 �: s1ete. e..
Does nt ovm MoD�Y in any ofher If yes. whet a� �' K� ((�� • .as Ihis tletlucGm Ecen rcGUrsted m
munty i�'vna7 . ��. mr wrtentY�R
❑ Yes No ❑ Yes No
' COUNTYAUDi.
Deduction appro.�ad in tlre amount oE ' .
20 20 20 _ 20 _ 20 20 20 _
Sig�Wre d CamtY AuErtw Counry Date (rmvh. daY Y��)
�� I I We certity urWer the penatty ot perjury that the above arW foregoing infortnatlon is true and cortect aM that the appli�ant is a resident ot IrWiana and
. amer I mntrad buyer of Ne aforemenboned property on date application is filed.
SlpnaN�e (oMneh hN lame)• ' Date (rtmth. daY. Y�/)
F ' ent aENCS. W appOtant ( ber and sneet �Y �te, erd 2lPaode)
N� I dr �I I C.� �/e v
eism autto�d Dy duy ezecuted Parer of ey or Ey IC &1.1-72-0.7 Date (rtionlh, dry, }Ba�
AAEress of auCv'¢ed person (number aM street c% atate. entl Z!P rode) .
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