HomeMy WebLinkAboutMortgage_Smiddy"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709 (R77 / 6-09)
�' t Presoibed by Depanment oi Lon� Govemment Fnance F
�L �LJFi�.�A9 '
INSTRUCTIONS:
To 6e filed in person w by maii wiN the CountyAud'ROr or Counry Recorder o/ the county where the property is IocatedJ C T ��0��
Filing Dafes: i) Real Pioperty: Must file during the year for which the detluction is sought. County Auditor
2) Mobde / Manulactured Homes nof assessed as Real Property Must file dunng tha tweNe (12) months
6efora March 37 ot each year the deduction is sought. '-yy� ❑ Counry Recorder
p'/6 — .f5
See reverse side (oradditional inshuctlons and qualiFKations. .- (�
Ma� m(mmerwcanfsnbuyer-seeresvirb�'a[aon rsesiYe) . � �� ��/ l� � UfV � V
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Ta 'ng Distrifl Key number / kgal dewiptian RemN num6er Page number
.�.�,�.�i,a� -�4_ ��_ �o� - o00 5`s3 -o0 9 aoo 9 s,6o
��a��,erty�a
al�eN yPa
at's his ! tm,� esact share ot
If nane m 2cord is diRerent ihan Nat N aPP��L h�dinte bebw
Name ot mon�agea or mntract seller
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Address of rturtgagee ar mntrad sr�er (number and sveeG �+N. state.
awner m
AdCRSS Ot d55kJIlEB (nUrtlbEf
rtqrtgaga
rRy, slare, ane z�v cade)
Oces epplit2nt avn poperty in anY oNer I If yes. what wunly?
munry in Ind'ana?
❑ Yes ❑ No
20
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Ci5
�aid as d Mongage I Con�act'vWebiednrss unpaid as M Is �he appl'usnf Ne sole
date o( appfxation kgal ar epufta6le ownM
� % � /Q ❑ Yes ❑ No
tt awned wiN someone ather than spouse. indicate wa�h wiiom
Is Me P�PertY in 9uesDOn: Mnua�y Pssessed
❑ Real ProPeKY ❑ ��a�H �
Y�I
Dra�ver NO...e�.`�........
Card NO. .....'�.�.�1.°.�.. • , "
.......
.� � ry 7, 8�/. °° .
couNn au
zo 20
Counry
p_
Date (monM, day, yea�
Y
20 _
I I We certify ifWer Ne penalry of�rjury Nat the above and foregoing in(ortnalion is We and cortect and tha[ ihe applicant is a resident of Indiana and
owner / contract Ouyer of the aforementioned property on date applicalion is filed. �
3�au� (c�me/s f�l rame) \ � /� .. .. , n n ..I _ _ n Data (�. daY. Y��
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Ey duty exewtetl Power of Avamey w by IC 61.
Pddress of aWwmed person (number aM sneet ciry. state.