HomeMy WebLinkAboutMortgage_Heichelbech"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
� FOR DEDUCTION FROM ASSESSED VALUATION y-
� Siate Fom� 43709 (R71 / 6-09) � pp
�'` � Pr¢soibed by DepartrtceM of Lo��I Govemmenl Finance p
Jl le Mark
INSTRUCTIONS: F� �� �p�.
To 6e filed in person or 6y mail with the CountyAuditw or Counry Recorder o! the county where the prop��s kcate$O ��
Fiiing Dates: i) Real Pmperty: Musf file dunng the year for which the deductlon is sought 1� � � Counry Audimr
2) Mo6Be / Manufactured Homes not assessed as Real Property: Must fiie dunng the twelve /12 monfhs
before March 31 of eacA year the deducfion is soughG �� J. ❑ Counry Recorder
See reverse side for�dd'4rona1 instmctions and qua�fications. ., � e �,,.. __ \
. . KeY �mOEr /
xre�v�au.rasor �/ �.x
)Rar M'
/ her e�oct sha�e of interest?
on r¢cwd a Eifierrnt Nan
of mor[gagee a tMtrac[ seller
Address af rtartgagee a mnhact seAer (nc
Name of assi9nee w oNer owner w hdder
�--aoo�/ sl/--o�
itract irqehtedness unpaid es o( MMgage / Cor
�� y� data of appOpt
uMi�ate bebv.c
stata. aMZIP
�f ascgnee (number aM stree4 my. sfate. and ZIP catle)
d�nt a,m pmperty in any otha I( yes, whal
Ind'ana? ❑ �
I—I Yes
�
20
IIWec
ownerl
Pe1sm
_, ao\a .......
��,`�\`C` `O \�
�q: �1
�j(� and fore�
� \� � � ✓'�„�rty on date ap
C�� /
i
ar�sLeet,
�.
authn'ved persw� (numbe�arid sLee{ city, s1a(e, an0
W�at Taang Distrirt7
COUNTYAUDROR
0_ 20'
. �"�'
RecorO number
o� <
unpaM az d
ttan spouu,
i�5�
�pikenl Me sde
epuitaGe ame(!
] Yes ❑ No
Is tM ProPertY in Ouestion: MnuaDy PssesseE
❑ Rea� Proaertv O au,ua�y wsussed
: Viis deduGim Ecen reVUesleE on piopeM1y
Q1fe��� n Yes ❑ No
�
Date (rtnNh. daY• Y��
�_
infortnalion is W e and cortecl arM that the applican[ is a resident of Indiana aM
ion is filed.
Data (rtmlA. EaY• 1'ae�)
(monN. daY.