HomeMy WebLinkAboutMortgage_Conrey"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ns ' r
r__ ; FOR DEDUCTION FROM ASSESSED VALUATION
' Stace Fortn 43709 (R77 / 6-09)
�' �u. ° ��� M�Da�m af Lomi Govemment Fi�nce
Fil
�NSrnucnoNS: � �p�� 2011
To be filed in person or by mail with the County u rtor o� ry R corder o/ the counry where the piopeRy is located. F� ��
F�7irg Da[es: 7) Real Property: Must file dunrg Ne year f r irh fhe deduclion is soughG C� q��
2J Mobile / Manufactured Homes rat assessed as Real Property: Must file dunng the tweNe (12) months
be/ore Malch 31 0/ each year Ne deduction is sought. ❑ Coun R
See reverse side !or additionaf insfnictions and qualficafions.
�, AppGCant (o r or convad buyE� �pst�s rn revey�a)
�Q.ADi ♦ �i..FL �A N
0.�esstd vaWe U real popaty as
AlarUi 1, dmni year
If no, wtut is his / her exaG share of inieresi?
Y�
If name on mmd is diRerent Nan Nat a( appfKant, inEifate bebw.
Nama of�e5eelle� �%�
r/,[X/�-
Address W mortgagce w contrad seller (nwnb M sbee; ciry, stare,
Nama of assignee or other owner or hdder of rtwrtgage
Addmss of assgnee (number aM stree4 �y. slate, aM ZIP cotle)
Does appFnnt ovm propeM in any olher
county in IMiana?
❑ Yes
Deduaion approved "u� ihe amount at
20
syr�n�re a ca,�n nwn�
20 � 20 _
20
-. • �iH
Retordruunber
000 6a y-o� q �L/.-//
�� unPaid as of MoM19a9e / Contra'ct iMebiedness unVad' az�
spo�se.
ont tlu sde '
litd6lC ov/ne(.�
Yes ❑ No
Is Me G�P�Y in vuestion: MnuaDY Ass¢sed
❑ Real ProPeKY ❑ MnualyAssessed
M1bdle Hwne fIC 6
i� r,�,�,�- � C V
VJhalTarim l�� �• / /"
V`ti'� _ /�^�"
1UDROR ��'�� �L�
�- `� � �Si ��� �
��� I I—��CI
I I We certify under Ne penalry of perjury that the above and fwegoing infortnation is We z
owri@r I contrad buyer of Ne aforementioned p�cpErty on dale applicatlon i5 filed.
i�dent�a(tl�tlres W�
aufMiBeC by Qi
AOtlress oi a Wm�rzea person
antl sLeet tity. stafe, antl LP ootle)
'of nameywCyICG7.1-�.7
i we,�4 ciry. s+ate. an0 Z!P mde)
� nl �17rQ�U��
n��(monN.EaY•Y��