HomeMy WebLinkAboutMortgage_Decker"'n STATEMENT UF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T s ip Ye
� FOR DEDUCTION FROM ASSESSED VALUATION
f-.. .• Siate Fortn 43709 (R17 / 609)
�,,,� � P�esaibed by DeP�k'ttl al Loral Gov2mment Finence
wsrRUCnoNS:
F�� 3 0 2009
To be filed in FOfm �� ��:
person w by mail with the CounryAuditw or Counry Recorder of fhe wun'ty wheie [he property is located. �y„�I �r
FiNrg Dafes: 1) Real Pmperty: Must fi(e durnrg fhe yaar for which (he deducGon is so ht. ��(
2) Mobde / Manufac2red Homes no� assessed as Real PiopeRy Must file dunng the fweNe (12J months G gS /fet
6efae March 37 0/ each year the deduction is saght. � C �A� 1 OR
See ieverse side for adtlitional instructions and qualificatrons.
MP�nt (mmer a�Lact buye �' see rasMr�br�s m reverse vde) ,.
artentyeer
no, what is his / her e� shara of interest?
It name m remd's dAferenf than that of app9cant �d'u�ate bebw.
sram.
AOdress of assynee (number aM shee4 �rtY, s1E3e, and ZIP code)
Does ePplimnt ovm praperty in enY other I If yes,
muntyinlrWiana? r-i __ r-i _.
20 I 20
_�
b�
Ifawnetl
COUNTY AUUITOR
20 20 _ 2b
Caunry
Recortf number Page numbrj
. bbR
Y cWeMetln¢ss unpaid a d Is Ne appGmnt the sote
legal w epuitade ovmeYl
e5 ❑ No
r than spouse, Udkate with wtwm
IS Ne WoO�Y ui pues�wu MmiaM AssrsseE
Reel PtUperly � MnUally 0.55essed
[�(l,�L [�91.� �e�l A-
0�'-5�a� �
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20 20
(monfh. daY• Y��)
I/ We certify urWer ihe penalry of perjury that the above arW foregoing intwmalion is Vue and cortect and Nat the applicant is a resident of Indiana aiM
owner I contract buyer of ihe aforementioned property on date application is filed.
lnatura (4�meh fu0 name) _ . /` Date (monfi. daY. Y�A
Cy tlWy esew�ed Po�w af Attort�ey ar Dy
persan �number aratl sbee; cRy, stale, and LP cotle)