HomeMy WebLinkAboutMortgage_Craney (2)^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n hi Year
_ = FOR DEDUCTION FROM ASSESSED VALUATION
• 51ate Fortn 43709 (R71 / 6-09)
S�.,� r Presaibed M Department ol Local Govemment Fi`arca
�rRUCnoNS:
pPR 1 �� �
To 6e filed in person w by mail wifh the Co�ntyAUdROr or Counry Recader o( the counry wliere the property is locate� .�, Fe � h:
Frfrreg Dafes: i) Real Pioparty: Must file during the year for which the deduction is sought. p��u ditor
2) be ore March 37 o each year the d ucbon g SpghProperly Must file during the fweNe (12J monNs N C uN A� �i�u�t�y Recordu
�
GIBSO
See reverse side (or addifional insVUCGOns arM qualifications.
MP��Lt9wnerocw)p'arlbuyw'see�strirAonsm2vyfsesde) .
Asesed ralue cf real p�opr�ty
Mairh 1. ameM yPar
It no. what Is tus I IiM esxc
on
�d 3v-3� o G a6 � a� � I�`°� r
ige / Contraa irdeEOedness unpaiO as of Mongage / ConVaY inCeMedness unpaid as d Is the
1. curtent yeer date of aPP�m�� legal �
Nat of appUCant'cidiram bebw.
na� m ��s� � �,� ��
Pdd2a of rtnrlgagce w mnttaU se�er (num6er
Name ot asvgnee or U1rer owner or �dder of m
AilCress of assynee (number aM stree4 u�Y. :
Dces aPWinnt own property in any oNer
munry in InCana? � Yes ❑ No
,
�uc0on aooroved 4� ihe amount oE
(y�a
tt avmed wiih somearre other ihan spouse,
c�A���y .��,�
��-0��10�/
If yes, whet munp,
�
�_RI�lIGI7
� ---
20 _ � 20
��N
number
iBable rnmeYl
Yes ❑ No
Is IM ptoperty in VueSion: Nuua%P55
❑ Real PmPenY ❑ �^�Y �
A1ob�e Fiartie
Has Iha deduttion Eeen rtquesfeC m 7�Y
(or arrenl yeaR ❑ Yes ❑ �
�
Date (rnoNh.
20
I/ We certity ufWer Ne penatty ot perjury Nat the ahove anA foregoing infortnalion is true and correcl and that Ne applirant is a resident of IMiana arui
owner I contrad buyer of the afaementioned property on date application is filed.
�vnimlovmefs�lliurnel w � Date(montli.daY.Yaa�
Fd� re�ent eedress of appfcan� (numDer and stteeCrJrslate, ard LP coae)
u�f,2D s Sl5 O/' Oalc 14..,� C,-Ey i_/J y7Gd �
erson authomed Dy tlWj exewtetl Power of AttomeY a bY IC 67.1-12-0.7
Ptldren of autlror'¢ed per'..o� (number aM sbeef, ctiy, slate. and ZIP code) .
yea�