HomeMy WebLinkAboutMortgage_Riley (5)'.t "'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_.. . FOR DEDUCTION FROM ASSESSED VALUATION �� �
Sfate Fortn 43709 (RB / 2-07)
�' ,�„ � Presrnbed by Department af Loml Govemment Firiance
Fil M
iNSrnucnoNS: NOV 1 0 �IU�
To be fited in person or by mad wrth the CourrtyAuditor o/ lhe co�rHy where the propeAy is located.
Fding Dafes: 1J Real Property: During the 12 rranMs before June if ot the year the deduction is fo be eflective.
2) Mobile Homes assessed wMerlC 6i.1-7: Behveen January 75 and March 2 o7tlie year the deducti ��e�
Sae reverse side for eddifional insWcGons a� qualifications.
GI N NTY
wfrt �tnnVad buyer - see re ' m reve de) O
// �f. OG . /J //1/�Q . ! E�l
vah�e ot real P�P�Y as ot Ma� 1
/0 ao-?l�c
�ee or cmLacl seller
� Address of mortgagee a mnVad selier
� Name of assgrree a olher owrrer u
Daes applica
county m �nd
c0on ap
20 �
t/Wecei
Indiana a
J Si9rahae (oM
anern year MMgage I ConUact
arteM year
� . �.�a�,
�� ��e�m�e ��
>araM Ctity,stafe, IPc
mort�a�e
elnb. an0 ZIP mde)
I��3_ ��oo
��t/R/ I �"���
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PerSOnauiha___" __' _"'"'_'. ___ _.._.... _�... � .f...-.�-...,
Address of au1Mr¢ed persai (num6er and street, ftiy, sfafe, antl LP wde)
� ao6 iys�3 ���
unpaid as ot March 1, Is ihe appfipnl lhe sole legal w equilahle owrre/t
❑Yes ❑No
med wilh someone aher Uan spouse. �cate wiN whom.
,swa��,���:
❑ R�I Pmperty ❑ Mobile Home QC G7.
`i'1'l�,a_.(1� _ 95-�705
Has tltis deduction been requas�ed an properry
(a art�t yrvR
❑Yes ❑No
INTY
� 20 20 _ 20 _
Cwnry Oate (rtimth, day, yea�
infortnation is true and cortecl and that Ihe applicants was / were a residenl of
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Oate (mmlh, day, yea�