HomeMy WebLinkAboutMortgage_Ball (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yeat
= FOR DEDUCTION FROM ASSESSED VALUATION ^
:� -- . .
State Form 43709 (R71 / 6-09) .�1 � �
� y�. � P�esaibetl by DePartmenl W Local GovemrtreN Fnance `J ` I
� �,j Y File Mark
INSTRUCT�ONS:
Fwm fDad with:
To be filed in person or by mail with the CounryAUdifor or Counry Recorder o/ u where [le¢ ��fy is located.
FMg Dates: i) Real Property: Must file durirn� the year for which the detluction is sough 1� �.�punty Auditnr
2) Mo6de /Manufactured Homes iwt assessed as Real Pruperty: Must fil�ng the 2) months
before March 37 of each year the deduction is sought. ❑ County Recorder
See reverse side foraddifional ins��uctions and qualificatrons. G?� U��'(OR
AGP��tJqx+�erorconfr�pbul�C- 25tric�°^ reversesitle) ..(l�1
_/(/_�%�
A95LS5e0 vMl¢ ot mAptaperiy as of e/ CAnb3ct vldeo
M1}md� 7. nrmY year �w�t ye�r�
�%
It �w. what is his I hu eYad share at interest?
tt fwrie m remr0 "s 6RerenllAan that N a0p�nt, ui0icate Celow
Name ot rtnrtgagce or mnttad seller �
Address of mM9agce w contrad seller (number eM sbee{ city, stete, arW :
Name of assignee m othrl owner or twlder of mort9a9e
AdEreSS of as9gnee (num6er aM stree4 ary. slate, and Z/P code)
Ooes aPplimnt wm property in any olher I( yes, what wunty.�
munry in IMiana? � Yes ❑ No
zo _
sy�amre
I/We
owner
�Sig�awre
Y
20 _ � 20 _
Recad num0er
)' O
tgage / ConvaG "uWebtedness unpaid as ot I
�. of applNation I
somearre ottrer Ihan spouse. iMkate wtth wha
Yes LI No
Is IM P�PenY in GuesOOn: MnuaOy AssesseE
�.e�i a�nr � ^`"'uany assessed
Mobile Fbme (IC 61.
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pl•a���er �0• c
Card 10. . ��•o `�.......
��(�5,550��� � ��'�
❑
20 I 20
� I �
rWer Ne penalry of perjury that the above and foregoing intortnalion is We and correU arM Nat Ne applirant is a resident ot Indiana and
ct buyer of the aforementlors9�property on date application is filed.
hA �� Dale (month. daY. Yea�
slate,
��Y sti� yi�G� o
Pason authorrzed Gy dWy eseaitetl Power af Attomey w by IC 61.1-12-0.7
AdEmss of aNha'¢ed person (numbei arM sbee; dry. state, antl LP code)
Date (rtanN, tlay, yxa� ,.
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