HomeMy WebLinkAboutMortgage_Buttrum"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township veai
_. FOR DEDUCTION FROM ASSESSED VALUATION
S�fe Fortn 43709IR71 / 6-09)
�,W Presm'Eetl �y DepaM1metC of Lool Govemrt�atLL Fu�amx
File Mark
INSTRUCTIONS:
To 6e filed in person a by mail with the CounlyAuditor w County Recortier o/ Mie counry where the property is bcated. �
Fitirg Dates: 1) Real Property: Must fi!e durirg Na }rear /or which the deduclion is soughG � Cqunry Audttw
2) Mobde / Manu/actured Homes not assessed as Real Property Must Re dunng the nvelve (12J months
before Maich 31 of eaclr yenr Ne deducfion rs soughG � �� Remrder
V
Seereversesidefwaddifionalinstn�ctionsarMqualifications. GIBSO �
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ti.�ssea vah,e a � u�r � �
Mart3i 1. a+�Mnt ymr
If ra, whal is his / her r.raC share of inleRSY7
tt rarre m remtl's
Name ot mortgagea «mntraa
cantract sr�er
Name of assignea a dher owner or hdder o1 moriga9e
Pildress af a�gnee (num0ar aM svee4 �=Y. �.
Dces appli�anl o.m prapGty
munry�nlndana? r
approvea'vi Cre amount ot
No
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�. / Contrati'udeMednass unpaiC as ot
amenc year
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LP mtle)
IF yes, what munl7/1
2p I 20 I 20 _ I 20
What Tadrg Distrin7
20 _
aecoro �umeer � Pagg M,mbe.
;��affi� �s�a����
kgal or W�ara6le oxnM
y� ❑ Yes ❑ No
mdxate wXh whom
pioperty in GuesOOn: MrivaM Asse�teC
�I Pmpertr Q amua�Nwsessed
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� I/ We certify u�er Ne penatty oi perjury ihat the above aM foregoing infwmation is We and corteG and tha[ Ne applipnt is a resident of I�iana aM
owner / contract buyer ot the a(oremeMioned propertY un date appl&ation is filed.
.1(Sia`aeirelow'e/sN➢remel Ai �e(�.daY.Yea/)
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�esiErnt aAtlmss of appl
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Psson autMraed Gy Ei9y e
(n�mberaM sbeeR �y, sbfe, arM
o� c�u,. e�y r�