HomeMy WebLinkAboutMortgage_Powell (3)^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun o ship
__ .- FOR DEDUCTION FROM ASSESSED VALUATION
� Stata Fo�m 43709 (R1L 6-09)
�` P�esaibed by DePartmenl 01 Loral Govemmenl Fnance
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JSTRUCTIONS: F� �� �:
To be lled in person or by ma�7 wiN the CountyAud'Rw or Counry Recorder of the wunty where the property is located. �-❑'
Filing Dates: 1) Real Property: Must file dunng the }rear (or which the deduc[ion is soughf. County�. r
2J Mobile / Manulactured Homes irot assessed as Real Property: Must fife dudng the tweHe (72) months R [.��
6efore March 37 0( each year the deduction rs saght. GI SOti'�.�0o tv�� � R
See 2verse side lor adtlitional inslruUions arM qualificatbns.
nppfuayy(ow.ce�moontr-�buyer-see�icoonsonreverse � I _ /1//
azd
no, what 5 his! ner eraft share
If n2m2 an rem�d
r/ legal des�7� � Recortl numDU Page numOPi
�. o . Uo% �3�-oG 7 � a i� 3S�C
�9a9e / CantraR iritlebtednrss unpaid as of Martgage / ConvarY "umtlebteMess unPa'vi as d Is Ne ePp6vnt the sde
M2�ch 7, wrtem year Eate af aVP��b^ /�%� V/'1('\ I�al ❑ YPSe ❑ ON
(/C! vU
If owned wit� someone other Man soouu. iMicate with whom
uWirare bebw.
Nartre ot mortgagee m m�tract seDer � n ^�
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AAdress ot rtaN9a9� ar contrad seDer (nuni6cr eM streeL G1Y, slate.
mortgage
(numDe� aM spee4 �rt1: s+ate.
Dces applimnt am property
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i any oNer I 1� yes. what munq/.� I What Ta�tl`g 05InU'
Yes ❑ No
COUNTYAUDROR
��� of
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� ca,�y
e property in QuesGm: MnuaOy Pssessed
Real ProPe�b ❑ ��M �
0.fodle Fimie OC 6
Dra�� er NO... a..°.�. Z...—....
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Card NO. .....'1.3.:s...�......
I IWe certrfy under Ne penatty of perjury Nat the a6ove ard foregoing intormalim is We and cortec[ arM that the appli�ant is a resident of Indiana antl
owner / mn4acl buyer of the aforementioned property on date application is fiied.
� Sig�aWre o�me/s
Date (rtrnth. dar Y��)
�Fu� resident of a t(numbe� and slreet, riry, state, and ZIP mtle)
��s �l \ � ��
Pgson authoraed Ouly executeC Power of AttomeY or by IC 67.1-12-0.7 Date (rtpnfh. daY. Y��
lbdress of aut}wrrzed pnson I�umberantl sbee; dry. state. andLPoode) .