HomeMy WebLinkAboutMortgage_Conner"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ � FOR DEDUCTION FROM ASSESSED VAL�I� �
.• State Fortn 43709 (R71 / G09) �
i f p�yy�pytl py DepaNireM of Local Govemment Fnance
�"" File Mark
JSTRUCTIONS: �/��7�
� ^ `Y Wn Fam t0ed with:
To 6e frled in person w by mail wi[h the CountyAuditor or Counry Reaorder of ihe dt ere�f��aroperty is located.
Filmg Dates: 7) Real Property Must file during the yearlw which the deducfion is sought � Counry Auditnr
2J Mobde /ManulacN2d Homes rrot assessed as Real Property M�st-fi(R,ejy�-[Ae twelve (12) martAs
before Mamh 37 0/ each year the deducfion is sougM. n---y ❑ Counry Recorder
v �-�
See reverse side (ar additional instructions and qual�cafions. \l
Appficant (owner m 6uXer' see ms�lpns re r�e sde) .
I �2hre af Ral P�P�Y ��
aa�era y�r
ro, what's his I hes erw share
If `wr�e on remrd
Name of morigagee a mntrafi aeDer
nmress or nwrtgagee «m,aan se9
u�me.af.ass5�ee or other aw�m1 w t
��, ��c�=[�z
/legal
u�tlitate Geb�r.
� 3��-000. 3��-oc7g � ao i 2-
1 hde6tetlri¢s unpaid as o( Mortgage I CantraG'u�CebteM�s unpaid as M
� � � date o( appliption
svee4 �fi! stafe. ard ZIP oode)
mort9age
Dra�ver i\iO....��.Z
� G .....
Card i\'O. ....... �, Q`i/�
...V......
20 � 'tu_
Sigrianne
I/ We certify urWer Ne penatty of perjury �t the above e
amer I contrad buyer of the afwementioned property on
If ownetl with someone dher ihan spouse,
What Taring D'abid?
COUNTYAUDROR
20 20
Caunry
ot aparanc (number arM sbcet tlry, s7ate, aM LP cade)
E l�. Sfi-«+ . t-kw y s-�
eWv esearteA Power of Mornev or by IC 67.1-t2�.7
person (num6er aM sbee; tlry.
t���
iplhanl the sde
epurtade avne(1
] Yes ❑ No
Is Ihe ProPeNY in Ouestion: MnuaP/ Assesse0
� Real ProPenY � A!?�!��Y.�
Has Uis tledud'un Deen requeste
far artent yeaR � Ye
20
Oate (nmlh. daY. Y��
� v�v�i
❑ No
20
infortnation is W e and cortect and that Ne applican[ is a resident of Indiana a�
ion is filed.
Date (rtmfh. deY• Y��1
5-7— /}—