HomeMy WebLinkAboutMortgage_Coleman (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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: FOR DEDUCTION FROM ASSESSED VALU� ��
� State Fortn 43709 (R71 / 6-09)
S w. � Prewibed by DepartmeM of Lod Govemmerrt Fnance
File Mark
�NSTRUCTIONS: 7 'n'7�
To be filed in person w by mail with the Counry Auditor or Counry Rernrder o/ the caunq��rAt�pmpevy is located.
Filirg Da(es: 7) Real Pmperty: Must file during the year fir which the deduclion is sought.
2) Mobile / ManuFactured Homes rrot assessed as Real Properly Must h7Edtl,qr�p�e�ei (72) marNs
befwe March 37 of each year the deduction is saghL (\ �
See reverse side 7or addiUOnal instrucGOns arM qualificafaons.
ptram(ownerorcontra er.seerestri;tionsm �rerse/�d� e)
�L/LQ�d�__ �� � + �d_
I Tap�a oi� 6�'� �r �ne� i �eyai aesc��
���
W�
I(1ro, what'a his / her evU
-/ ;3 �-�`/0 3 �bG ,
Mortgage / Contraa iMnbteEness unpaid az W
Marti� 7. artent yrar
If �wne m mcwtl is 6Beren[ Nan ihat al appficant, i�Mit�ate bebnc
Name ot rrortgagee or mntract seller
rtiortgagce n
or otner owner or ndaer ot rrortgage
sbre, arN
ACCress of asvgnee (number aM stree; tlry, state, and Z/P ootle)
Does aPW�nt ovm properry in any oNer I It yes. what munM I NTaI Tavrg
munty in InCiaria?
❑ Yes ❑ No
ction approveE in tl�e amount oi:
zo zo 2o zo
• i , i
I I We cerii(y under Ne p� nalry ot
owner ! contraa buyer of the afon
..
mmearre
-
Fwm filed wNh:
Caunry Auditor
- Counry Recorder
RemN mimbv Page numDer
p a �/ Li
btedrress unpaid az of is Me appGrant the sde
legal w epuiHde ovmel.+
❑ Yes ❑ No
spouse, iMitaie weh whom
V�PenY in QueStim: MrwaOy As5eS5ed
eal PrUpeny ❑ Annualy Asessed
Mobile Fbrtre (IC 6
�wsted m_�ropeny
Dra�ti er i1`O.. ....o'�. 0(a�
1�5�Pr .....
Card !\'O. ..... I'
#a n�edl C �,Q�� '
�U`t
o� ��,a... ,..
that the above and foregoing infortnalion is We and correa antl Nat ihe applinnt is a resident of Indiana and
ned properry on date appiication is filed.
by IC 67.142-0J
person lnum0er antl snee4 t4y. sbfe.
Date (manN. daY. Wa�