HomeMy WebLinkAboutMortgage_Farmer"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Fortn 43709 (R71 / 6-09)
�,,,, , P�esaibetl M DeD�rrt of LnrW Govemmenl F�rcx
a
�STRUCTIONS:
6e �led in person w by mail with the CountyAuditor or Counry Recorder of the county where the property is located.
Frlirg Dates: i) Real Pmperty: Must file durirg Ne yea� for which Ihe deducGon is sought fCounty Auditor
2) Mo6de / Manu/aclured Homes not assessed as Real Pmperty Must fiie dunrg the tweHe (12) montF� � V � I��ry Reco�du
6efore Ma2h 31 of each year the deduction is swight.
See reverse side !or addiUOnal insWCdons and qualifications. C'�'
App6mn raconbaa6uyer- re5r"raonsmre side)
� �a��p,� � a�- IBSON COUNTY AUDITOR
Ta ' Distrct Key Der l legal desaiption RemN rwmbu Page number
� - � �3 - yoo - 000. ��d -oo o! � � �4 �
As�sed vdlue d rnal property az oi �age / Contraa InEebtediress unpai7 az U Mor�qage / Contrart iridebteCness unpaid as o( Is Me epd�t Ne sde
Nazch 7. arrmt year MarG� 1. airteM yrar dale o( appfuation legal w equitable owneR
DOD ❑Yes ❑No
� If ra, what is his / her esafY share of intelestl If ovmed wiN someore aher tl�an spouse, iridirate wNh whom
If fume m remd is EAlerent lhan Nat of app
rtqrtg3g¢¢ a COnUatY seller �
s of rtnrogagee or contraG se�er (n�mheland so
W assignee or ather owner a Mider of mortgage
AGdress oi 'gnee (numberaritl s
Oces applimnt own pmperty in any
counryinlMena? � ..
amoum oF
20 � 20 _
I I We certify under the penalry oi
owner I contract buyer of the afon
autMrrzed Dy d�dy esecuted
: of authu'ned persa� (num
sfa�. aM ZfP codej
s/ale, erd ZIP mCe)
_ 3 - i ,-,
.�3 ,4 L
WM, Taxmg DitVrl�
COUNTY AUDITOR
20 � 20 _ � 2b
IS UIC P�PQrtY 111 QUCSLq11: Mf1112P� ilS5CS5L'�
❑ Real ProPenY ❑ ����Y ��
Modle Fiorne fIC 6
nr�„���- �o.....aQ1.1......
Card \O. ...1�61•[•.7........
Counb Date (rtroiIIh. QaY. Y'�h
that the e arM foregoing infortnation Is We and correc[ arW Nat Me applipn[ is a resident of IrMiana aM
ned on date applicatbn is filed. '
Date (nmC4 daY. �)
n0 ef. dly, sfa7e. antl LP ootlej
IiV�S�-�
dAitomeY or by IC G7.1-12-0.7
sbeef. ciry. Sfate. aM ZlPcade)
Date (month. deY 1'�A