HomeMy WebLinkAboutMortgage_Keeker (2)"'+a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,.__ • FOR DEDUCTION FROM ASSESSED VALUATION
� State Fartn 43709 (R71 / 6-09)
S � PresaibeE Oy DepartmeM of Loml Gavemment Fnance
�JSTRUCTIONS: �onq t�p�h
To be filed in person w by mail wifh the CountyAud'rtor or Counry Recorder o/ Ne county where the pioperty is located.�,4 N 1 1 [U I[�
F�7"mg Dates: 7) Real Pmperry: Must fJe dunng Ne year for whirh 1he deducUon is soughL � Counry Auditnr
2J Mobde / Manufactured Homes not assessed as Real Property Mus! file dunrg the tweNe (72J months` �
6efore March 37 0/ each year the deduclion is sought. ounry Recwder
See reverse side for additional insWClions and qual�cations.
i
MoGcant (owner orcontrac{ buYer- see msviU�'ons m reverse si0e1 l
EeSdipUan
i.//- �100-
x rea� poper,y as
Y�
If ro, what is his / her ezxt shara
11 fwne m recwd is drtterent lhan Nat af appfianl i�Wip[e beWw:
Name of rtwngagee or mntract seller f
J
Addmss of mM)agce or contrad seller (num
owner w
Wa�
strtel, city. sfate,
51ate. antl ZlPCotle)
� i�-a-9
Oces apptirant ovm property In any oNer � If yes, what munry?
counry in Ind'0na?
❑ Yes ❑ No
Deducum appmved'm Me artaunl
20 _ � 20
Sgfatlrte
7-
someorre otRcr than spousa.
Rem�d number Page numEel
I lo �f 93
unpaiE as d Is Me apptirant Me sde
kgal or equilahle ovmM
❑ Yes ❑ No
e'vate wVh whom
Is Ne praperty in puestion: Mnually AssesseE
❑RealP1ncertv ❑.Mn,uanywssessed
�J�/,y�� 1/[�,
NRat Taarg Di ��/�`� �/� � y Ci
�
���
l I -1�y�i.3
20 20 c� � c� �
Date (rtq+vh. OaY. Y��)
.�
II I We certify under Ne penalry of perj�(fj that the ahode anC foregoing infwmation is We and cortect arM ihat tha appizant is a resident of Irdiara and
owner I contracl buyer of ihe afaemen[ioned property on date appliption is filed.
X Sig�ature (owners fiID name) Uate (rmvh. day, yeah
/li,_,<i,LPO� �P�n � O!-lrJ-„1U/a.
Full resitlent aCdress
stare.
0
w by IC 61.142-0]
Pddress of auC�ar'vN persai (number antl sbee4 �3:.s+afe. and
Dace (rtanlh. tlay.