HomeMy WebLinkAboutMortgage_Ayers"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ : FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R71 / 6-09)
�' ,,,, � Presaibetl by Departrtrent of Local GovemmeM Fnance
.'
�STRUCTIONS:
am d
b 6e filed in person w by mail wiN the CountyAud'ROr w Counry Recorder oI the Counry where the ploperty is Iocated.
Filinq Dates: 7) Real Pmperty: Must file during the year for whicfi tha deduction is soughG � Counry Audimr
2J Mo6de / Manufactured Homes not assessed as Real Property Must file dunng the tweNe (72) monfhs fi1C � n nty F���der
before March 37 of each year the deduction is sought. �L ���•�
�See reverse siUe�.�or additional instructions and qualfications. C��_ _
I rv+P�nt (owne C 6uyer- see re�m rev�rsa sile) � �i . l� �� I
DiStrkt
� u c.i • �o {.� � i J m o
brtpage / Contracc'vMebted�ress unpaitl as W Mortgage I Cmbact mde6tedness unpaid as ol Is Ne appfimn� Ne mie
lard� 1 rte t Cate o( appfrat6n legal w epuitade owner?
��an� r,Y�oNo
share of intr�t? � tt rnnred wiN saneore otMl ttan spause.
1! name on remrd is ddtemnt ihan Nat o( aDP���• �itate Eebvr Is tlre property in puestion: MnuaOyAssesse0
� ❑ Rral Properry ❑ MnUally Assessed
M1bWle Hane (IC 61.
��o��a�,��� S�/3
ACd2ss of nprtgagee w mntraa u4er (numbrl aM stree4 �T; sfate, aM ZIP code)
Nama of assi9nea or oNer awner or holtler of rtqrtgage s _ _ _, _
AOCress oi assignee (number aM atree4 �l: slate; : ��`�j �/ � n L QG�/`-� �'
� /i
Does apptiraM oxn PmPPrtY in any oNer `l �^ (� �//� �Has U�is deeudini Eren rW uesteE on pioperty
munry in Indena? ❑ Y25 ❑ No lJ �' for artent yea(.+ ❑ n
l' ❑ Yes
l 1 � / lY V
DeducGan approved in ihe amount
zo � zo � zo _ � zo _ � zo � zo � zo
sg�n,re
ca,�m
� I I We certify undu the penalry of perjury that the above and foregoing infortnalion is W e and cortec[ and that the applipnt is a resident of I�iana and
owner�traa buyer of the aforementioned property on date application is filed.
e(o s reme) Date (mwiN. day, yea
� /� .. ... _ � �_C�_Ir
Gy tlWy esecuteE Powe1W AVaneY a b'Y IC
Mdress W auNa'sed perwn (numDerantl sneet.
�ate (�N. tlay 1'��)