HomeMy WebLinkAboutMortgage_Maikranz^'� STATEMENT OF MORTGAGE OR CONTRACT IND SS ou n�p �
_ s FOR DEDUCTION FROM ASSESSED VALUATIO ��
'_ ' SlateFOrtn43709(R77l6-09)
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To be filed in person w by mail with the CountyAUdROr or Counry Recorder o/ Ne county where�t�ie prope is ocated. F�
Filing Dates: 1) Real Pmperty: Must !de during the year for which fhe deduction is sought. �1 �. i r
2J Mobde /Manulactured Homes irot assessed as Real Property: Must (d�g�q t��f�e�(�1 �(J�ft GI SOI�i p��� �R
6e(ore March 37 of each year Ihe deduction is sought.
See reverse side 7or addifionel instructions and qual'fiications. UNTY AUDI70 R
As�sseG rdue d reat Pmpe+tY a ot (^
MeRh 1, amcvY year
rc no, what ¢ nis � ner eraa snare o� i�tr�es�?
If name m reco�d is tliffe�rn� Nan that of applicanl
a„�„ v ,.=,..,1�/ ��%
� .
Convati irdebtetlrKss unP� as of Mortgaga I ConVSCt udebtedrmss �m4mid as d Is tlre aPP�t the sde
' nt r Cate of apP�tian kgal w itade awnef.�
Ye5 ❑ No
If owned wi� someone dher llun spause. i�d'x�ate with wiwm
e�,: Is tl�e property in 0��b^: �nuallY Asseste0
ea� Proaertv ❑ lvmualN Assessed . . .
Name M mort9a9ee a cmVaG seller y ' 1
N �
Adtlress of m�t9a9ee w mntraa se�er (nurtibe� and snce4 �Y. state. aM i
Nyme W asignee w dhei owner w hdder of mon�age
AilEeess of assigriee (number eM sbee4 �: �e, and ZIP ootle)
Does applinnt ovm pmperty in any oNer �-.p If yes, whal count/1
; nry in Indiana? � Ye5 LS No
tluction approved'm ihe amaum of:
p zo _ �
�,awa or can�n �we��
I/ We certity under the penalry of peryury that the
owner I conVact buyer of the aforementimed prc
Fln�l
bY
Has Ihis detludion been reQUested on propeny
(or wrtent yeaR � �,� � No
r aoi :� .......
Dra���cr \0........ ....... oa�c,,,�,,.e�,r�� zo_
�102�I
Cnl'(1 NO . ..............
... .... .........___..._ ___ _.._ ..,.....,., o��.. ��at the applirant is a resident of Indiana arM
� on date appiication is filed.
� Date (rtonth, day, yea�j
I
a IPOOtle) ��']
�
_. �_��r� Date( .tla,
person (numberaMStree;firy.sfate,andLPOOde)