HomeMy WebLinkAboutMortgage_Benefiell_^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
= FOR DEDUCTION FROM ASSESSED VALUATION
• $bte Form 43709 (R11 / 6-09)
�' l P�esvibed by OeparVneM of Lo�l Govemrtrerit Finance
INSTRUCTIONS: � �
To 6e filed in person or by mail witA the CountyAuditor o� Counry Recortier o/ (he wunty where the pmperty is 1 ed.
FiNrg Dates: i) Real Pmperry: Musf fJe dunng the year lor which the deduclion is sought.
2) Mo6de / Manufacturcd Homes not assessed as Real Propelly Must fi!e dunry the fweNe (12) months
before March 31 of each year the deduction is soughL N(
See ieverse side for additional insWctions and qyali�cations. . _
�a � �i t n �� �urnuer r re� eesx�pwn
- 0'-
Assessec raWe d real prapeny as d Mortpag e/ Coniraa u
Martli 1. wrent y�r Merd� 1, airtent year
If rq, what is ha! her ezafl share of intrlest?
If name m remtl's d'Afemni Nan that o( app0onl, hMirate bebw.
Name oi mort9a9ee or contract u
Address of mortgagce w mntran
cdy,
Name of assignee or othu owner w twlder of mortgage
PdEress of assignee (numbei aiM stree; dry, stefe, and ZIP cade)
Dces applipnt ovm property in any other If yes, what
munryinlndFana? n .,__ n .,_
zo i zo
, urJV. o _ oo(
ness unpaid az a( Mongage / ConSac
date of appficatim
If ovme0 with someone ocher
File
p�''p 2C�o�unaty Auditor
l�i 51011o1y Recorder
unpaid as of Is Ne appkant Ihe 5oie
��l , kqal a epuRable oxnM
(,l ❑ Yes ❑ No
;po . indipte wiM whom
Is ihe praperty in question: MnuaOy Assessed
❑ Real ProPeKY ❑ !���h' � ,
far uirtern yeaR
Dra���er NO..� �?� 9..-...
—� Card NO. ... y � �.9........
synan,�e a counry nuano�
I I We certiry under the penalry of peryury that the above arW to _
owner I contract buyer of the aforemenlioned property on date ap{
FOtl RsiOmt adGrss N appGc
Per�„on au �aed by Ouly eYi
Address of auNa'ved person
Powerof Atrnmey or Dy IC 61.
her and sbeet. cily. sfate, and 2
ste0 m P��Y
Yes ❑ No
���
; yea�
ideni of Irnfiana arM
is filed.
Date (monN. day. Ysa�
�