HomeMy WebLinkAboutMortgage_Puckett"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ro vear
; FOR DEDUCTION FROM ASSESSED VALUATION
State Farm 43709 (R71 / 6-09)
S,.,. Presrnbed by �epanmenl al Laml GovemmeM Frence
File
INSTRUCTIONS: rf � fl� �:
To 6e filed in person w by mail wifh (he County Auditor or Counry Recorder o/ the county where fhe property is locafed.
Filir'g Dates: 1) Real Pioperty: Must fde durirg the }rear (or which Ihe detluction is soughL � Auditnr
2) MobBe / Manufectuled Homes rat assessed as Real Property Mus! Ae dunng the twelve (12) months �
6efae March 37 0/ each year Ne deduUion is sought C Recwder
See reverse side loraddilional instructions arM qualifications. pIBSO ��
AppJf�nt(owne`�mnvaaQuyer'see�qQm'ao^s sde)n 1
ro,
��
jsficY Key number I legal desmption
.�,,,,�-�«� a� -i3 - d �_ �,
i vaNe of 2a1 pmpertY as U MoRgage / Contract'v
amnt yrar Mard� 1, wrtent year
�J
e7P��t'oi0icate beb�r.
Name ot mortgagee or rnntract u0u �/�
/
ACdrea of rt�ortgageP w mntract sn�er (number aM sfree4 �y. sta�e, aM i
Name of assignee w othu owner rn hdder of mat�age
AAtlress of assigrree (num0er eM sbeeL my. slate, and ZIP mde)
Dces epplipra ovm property in any oNer I( yes, what munt/1
munry in Ind'ana? ❑ Y25 ❑ No
Dr�ucEon approved in tice amounc oF.
20 - � 20 - � 20
piature of Caunry /wdimr �
J
I/ We certfy u er the penaly of
owner / contracl buyer of the afor
�(owne/sfiNre )
/
�`.�......)O
n residem address ot app6dnt (num6e
_ oo�. 3�Y-vo � .LL�oo y �_ss �S
�ess unpaid as of Mwtgage / Contral3 indebtedness unpaid as o! Is Ne eppikant the sole
date of appli�ation legal w equitade amM
❑ Yes ❑ No
If awned with mmeofre other than sD�e. md'vste with whorn
� Wo7enY in Cues�m: MnuaDY Assesse0
Real Pmperty Q Nvwally Assessed
— Dl'a i��er �\'0....a ---- ---_
:, :��,:. ..
� c���d,��o. : : � 55?S ' o No
4UDiiu� ��1 I�O,�� •
20 20
Caunry
20
Da�e (rtronfh, daY.1'��
ij�]
the above arW foregoing intortnaUon is We a�W corteG and Nat the applinnt is a resident of IrWiana arW
property on date apP���bon is filed.
Date (mordA. daY. Y��
shee4 dN. state.
w by IC 61.1-12-0J
Add2ss of authortred person (number aiM sbee4 GN. ��.
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