HomeMy WebLinkAboutMortgage_Barrett (2)"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n 7o ip Year
_ : FOR DEDUCTION FROM ASSESSED VALUATION
� . :• State Fortn 43709 (R11 / 6-09)
�' ,w � Presaibed by DeG��M of Loral Govemment Fu�ance
wsrRUCnoNS:
SEP E�'�^^��9
To be filed in person w by mail with the CountyAudiror o� Counry Recorder o( fhe counry where the pioperty is located. F� �� ��/�
Fitirg Dates: 7) Real Property: Must fJe dunng the year for which fhe deduction is wughG �qr,ounry Auditw
2) Mobde / Manufactured Homes not assessed as Real Property Must file dunng the IweNe (72J months GI—I ����er
betae March 37 ofeach year[he deduction is sought. GIBSON OUtvil'(
See reverse side 7or addiliona/ inshuctions and qualifications.
ApqGrant (Qwner or contraC buyer- see resfApiw�c m re side)
a�.�.�r,t ���i8tl3lo-yoa -000.
aFrrdl prcpeny as N Abrtqape / Contract ud�tedn�s unpaid az ot
.year Mamh7,artentyeer _.
1( ro, whaf 6 tris / her erad Share Of inte�e5l?
tt name m rcmtd'o Eilfaent than that ot app6�nt, 6Wu
Name ot rtnrtg3gee b cMtraG SWer
Address W rtnrtgagee w contrad sr�er (number and s0
Name o1 assignee w othel owner rn halder of mortgage
Pdtlress ot assignm (nurt�Der antl sGCe; aly slate, ana
Dces applaant am paoperty in any oNu
counry in Indiana?
❑ Yes ❑ No
Deduction appmveE In the amount of:
20 20 _
Sig�atura of Camry Audimr
ee; �i�, stam, aM LP code)
1/
LP code)
u yes. what ca,ncy�
�o�N
20 20 _
Remrd numt
3s� - aa 9 aoo
Mwigage / ConSaa uWe6tedness unGaid as d
date of appfication
Pa e numbrl
� � �
Is Ne apd�+t the sok
legal a equitade ameYi
n Yes n No
�e PmPertY in Vuetim: MmuOy Assessed
Real Pmperry Q ArmualyAssessed
MoWle Fiartie fIC 61.
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20
�Y
1/ We certify under Ihe penatty of perjury that lhe above and foregoing infortnalion is W e and correct and ihat the apptirant is a resident of Irdiana arM
owner! contract buyer of the aforementioned property on date applicatlon is filed.
�
Full resident eddress
slate,
1
Address of aWiatrEd pei5o� (number aIM stree( Uy, slale, and LP code)
-1
Date (monW.
Oate (rtronfh, dzY. Y��