HomeMy WebLinkAboutMortgage_Nolan� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
FOR DEDUCTION FROM ASSESSED VALUATION
� • State Fo�m 43709 (R77 / 6-09)
,' �«. � Presaibetl M DePa�M of Lorsl Govemmem Finance �
INSTRUCTIONS:
b be filed in person or by maii wiN the CountyAuditor or Counry Recorde� o/ Ne oounry where the property is located.
Fi!'mg Dates: 1) Real Proparty: Mus! fite durmg Ne year hu whirh the deduction is sought. A`( 1 g
2) Mobde / Manufadured Homes rat assessed as Real Property: Must h7e dunrg tAe fwelve (12�rtwnNs
6efore March 31 of each yeer the deduc0on is sought.
See reverse sy�e for additional instNCtlons and qualjFeations. �� �
Asxssed vaNe d real qoperty a� ot � I Mortaage /
MarM i. amH,Rar l f Mamh 1. o
`/
If m. whal ls tus I hw arxt share Of inte�est7
If name m'emN's Cilferm� Nan that of appWant hdicate 7
Name or nnrtga�ee ar mntract seuer �/ l/ 1� W
Address of rtnrtgagee or contraa se�u (mmberend sneet �y. sfsm. a LI
Name W asvgnee or oMer owner w taldu d rt�ortpape
Adtl�ass of asagnea (num0e� arN saeet aTy, sfeR. end Z!P catle)
Dces applicant i "-1 1l � O
counry n IMen � . . O�CI
D1'a��'er \0 ...................
���� Card NO. o��.�.......
V
>3-06/.
i az d Mongag
Cate of s
n awnea wttn som
�
NTYAUDROR
Distrirl?
Year
� unrynudimr
❑ County Recordu
Recoid mim
unpaid as d Is ihe
legal �
Yes Ll No
sPOUSe. uWk�afe �Nm Ht�om
Is Me property in Quesiion: Mnue�y Assessed
❑ rteal aroaenv ❑ rumua�y assessea
Has Nis deduction Eeen reQUesLLM m praprny
ro, cunern r��' r� .. r-� .
Zo_ 8D�5� � Zo— �— �—
/We
Caunry Date ( J 'Y �! /
penalty of ' ry Mat the above and foregoing infortnation is true and cortect arid Nat Ne applirant is a resident of IrMiana aM
of the atoie lioned property on date application is filed.
U
Pe�sm auq�waetl by duty exew[etl Power o( AnorneY or q' IC G7.1-12-0.7 U I Oate (monN. OaY. Y��
Pdtlr¢s of a W�a'ueA prlmn (number aiM sneef, ciry, sfa�e. eM LP code) .