HomeMy WebLinkAboutMortgage_Reed (11)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_,. ; FOR DEDUCTION FROM ASSESSED VALUATION
. . State Fortn 43709 (R11 / 6-09)
�,.�. ! Presaibetl by �eparlrtreM of Lacal GovemmerLL Finance
File Mark
INSTRUCTIONS:
To 6e filed in person or by mail with the CounryAuditor or Counry Recnrder of the counry where the property is located. F� �� ��
Fitirg Dates: 7) Real Pmperty: Must file during the year for which the deduc�ion is sought. � Counry Auditor
2J Mo6ile / Manulactured Homes not assessed as Real PropeRy Must fi/e dunng the fweNe (12) months
before March 31 of each year fhe deducfion is sought Cou�tY Rem^der
See reversa sid lw addifional inshuctions and qu lifications.
MGrram ! oonrrad nuyer'see mu�eor�s rcY� �) . /
Key �wmber / iegal desaipmn
a -� -
Mortpage / Contraa u
Mard� t, arrent ynlu
If fwrie m r�mtl is EiRerart than that of app6ranl, 6Mirate bekw.
Name of martgagea «mntxt
mortgaga
assgnee �numcer arm sueeG a+y. s+ate, em t�r tooe)
Does appli�ant ovm pmperty in any oNer
couniy m Ind'ana? ❑ Yes
De�uman aoomveE in Ne amount of:
20 I 20
tt yes. wnat
20
az
If owneC xith someane
RemN number
w epuRable ov/neY?
❑ Yes ❑ No
Is me prope`ty in a�estid,: anouauy wssessee
❑ Real Property ❑ Mnualy F�sus:,ed
Dra��•cr �0...�`'.�.......
Card \'O. ...�.J.�.�.........
���I.JL.I/. �
20_ � 20_
Caunry
20 _
Dale (monfh, daY Y��
� moaPm
, ❑ No
20 _
I/ We certify under the penalty of perjury Nat Ihe above and foregoing in(ortnation is true and cortect arW that ihe applinnt is a resident of Indiana arM
owner I contraG buyer of the afwementioned property on date application is filed.
inaWre (ok+�rs lu/l rartre) �. Date (rtronth, daY•Yaa�
esecuted
P4dress of authorrseO pereon
:gf, tlry, state, arM ZIP ootla)
ti S�` D�.
mey or by IC G7.1-12-0.7
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