HomeMy WebLinkAboutMortgage_Atkins^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownshi Year
__ . FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fortn 43709 (R11 / fi09)
� � PrPSaibetl Cy DeparlmeM of loral GmemmeM Firerce
� File Mark
wsrRUCnoNS: M
To be �led in person w by mail wifh (he CountyAuditof or Counry Recorder of the counry where the pmperty is located. �
Fi/ing Dates: 7) Real Pmperty: Must file dunrg Me year for which the deduclion is sought. Auditor
2J Mo6de /ManulaUured Homes not assessed as Real Property Must hie during the lwelve (12) months
before March 37 0! each year the deduction is soughL ❑ u ecorder
OR
See reverse side /or additional inshuctions and qualifications. G�gSON
A�d'rarll'(owne� orconbaU 6urer- see restrirbont m 2verse silel
, IKeYtWmber/
a�e �a,e a rea� v�r as a
Ma2i� 1, ammt ym
Name of mxtgag Pr mntraU seller
ACdress of mor[gagee w mntrad se0er (number ana
Fwne or assg�,re a aner owne� o� haae� m �wrty:
Ad�ress oi assigriee (num6er a� SbeeS �; slafe, :
Does appiifanl wm property in any other
munry in IMana?
❑ Yes ❑ No
Deduction approveE in the amount of.
\ 20 _ 20
1
1 SiSretum d CamN Aud»or
I I We cerGfy under ihe penatty of perjury th
owner I contracl buyer ot Ne aforeme,rtion[
.f:^i.+i
duly executed
> "�o oo� � �s-c� aor /�7
ntract 4deWetl�ress unPaid as U Mongage / Convad'vdebted�ress unpad a d Is Me ePC�t Ne sde
�nt year tlate o( aDpfmation legal w epuitable mxrnYl
% S � ❑ Yes ❑ No
If owned wiM someane aher tlan sprn�se. iMwate wiM whom
P�P¢nY in Questim: MnuaM Assessed
� �oPeny p �vmuanywsse��
cdy, 5ate. aM ZIP code)
` 1 I
, . � ,, °
1 '
t • ,�, � � f � � ���
.,j �
antl sfreet, ciry, stare, antl LP ootle)
by IC 61.1-12�.7
AdEress ot author¢etl person (numbereM street, city, stala, aiM ZIP oode)
o�Otl — (Co7l
� 9 9, '7 50 . �