HomeMy WebLinkAboutMortgage_Sandifar^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ : FOR DEDUCTION FROM ASSESSED VALUATION
• State Fartn 43709 (R71 / 6-09)
��' � PRStlibed M DePa�M Of Lool GwemmCM Finance
File Mark
�NSTRUCTIONS: J
To 6e filed in person of 6y mail with the CountyAuditor or County Recorder of the county where the property is located.
Filirg Dates: i) Real Property: Must file during fhe year /w which the deduction is sought. C,�
2) Mobr7e / Manulactured Homes rrot assessed as Real Pmperty: Must file dunng the twelve (72) monfhs
6e(ore Ma�ch 31 0/ eadi year the deducfion is sought.
Seereversesideloradtlifionalinstructnonsandqual�cations. GIBSON (
p�operty as d
If �w, what Is his / trer exa�x share of interest?
If n2rtie on a�corC is dMeren�
Name N rtnrtgagee ar cmirarl se�er
of assignee w
fl]
Auditor
Recorder
Is Ne appfiw�i Ne sole
legal a eQUttahle amel!
n Yw ❑ No
owned wiN someorre other �han spouse, iMicate wilh wtwm
uWiCare Gelaw.
wntraC se�er (num6ei and
naaress ot ass9nea �numcer am sueet
Dces epplitant ovm property
muntymindana? r
�
mortgaBe
— �y�—�.z,�A�. EG���� sa�,alr�
state
any o�her I '�
ve� ❑ N�
app�ovea m ure arroum or.
20 _
(%=�
i
Caunry
Is tlre VroPertY in quesUm: Mnua%ASSessed
❑ Rea� aocero ❑ nrmuaM w�sessea
Mobile fbme (IC 6
Has Ih's detlud'wn Ecen re9uested m PmpenY
forwrtentyeaR r'1 .,__ f"l �
20_ � �_
�r, r�A
I I We certify under ihe penalry of perjury that lhe above and foregoing infortnation is We and cortect and ihat the'applicant is a resident of IrWiana aM
owner I contracl�buyer of Ihe aforementi Droperty on date appliratlon is fiied.
�//�ynp�� /��e/�r oate (rnmrn. daY. rBaA
/ / UIiIw'.1/ `. 1.�. _
Pelson
AGdress
Dy tluty executetl Power of Attomey m by IC 61.
eed person (numberaiM svaef, dty, state, and Z
Date (monlh, day.