HomeMy WebLinkAboutMortgage_Gabe""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun To shi r
,; FOR DEDUCTION FROM ASSESSED VALUATION
• � State Form 43709 (R71 / 609)
�' w. � Presm'betl try �epanmern of Loml Govemmerrc Fuance
wsrRUCnoNS:
D€"� "l`'� 2 �
To be fifed in person or 6y mail with fhe CountyAUditw or Coun Recorder of the coun where the m F� �� ��
b' h P Pertl' is rocated.
Filirg Dates: 7) Real Property: Musf file dunng Me year (or which the deductlon is wughc C�qty q�dRp�
2J Mo6r7e /Manu/actured Homes not assessed as Real Property: Must h7e during tha tweAz (f 2) months rv �
6e1ore March 37 01 eadr yeor the deduction is soughG G�BS N � N Coun�Recorder
See reverse sida 7or addilional insfructfons and qualfirafions. '
t( rorm�aC�u)er-seere mreversesii ) /
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CL.<l �' lt-rJ
�?a�d istriG / Key�Wmber/I¢paldgaiPtlP� _ �. _ RetortlnumCa Pagenumber _
,.,,.--,-. ;,+,
ra. wnai 5 tus / trer e�C
tt name on recwd'a Qdfemni Ihan Nat of
Name ot rmrtgagea or mntrarl seDu
� ' ' Cs:(J ' C�i./' E.I.LJ. ! O '
Alortpage / Cantraa Indebted�s unpaid az W Morigage / G
Marti�1,WRCnty¢ar Eateof2ppfc
tt avmed wiN someo�
'_ uiEirate Deb�r.
Address of rtartgagce w mntrad seAer (mimber end streeG ub, sbte. aM i
Name ot assignee w oNU a�qr qr Ipider of ge , ,
( L�T /nn0
noares ot 'f�
assi�re (numbei ard street �: �. antl LP catle)
Ooes appli�ant own pmperty in anv oNer Ii yes. what munfyt
�,�uy �, i��a
❑ Yes ❑ No
Detluctian approved in ihe amaunt af:
�
signawre ot CoimN nuaimr
20 _ � zo � zo
hMebteMess unGaid
Yes LI No
SpouSe.
Is Ne VbOertY in Question: MnueDy AaesuE
❑ReaIP'oPenY ❑?�!�!!�Y�
DisC �� j '� "-��m.Gxn reOurJeO m P�Y
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I I We certify urWer Ne penalry of perjury that the above and foregoing intortnation is true and corteci and Nat the appiinnt is a resident of Indiana ami
owner 1 mntract buyer of Ne aforemeirtioned property on date applicatlon is filed. �
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t
� Full
PGtlress of aWiof'ved persm (numDer and sbee; dry, state. end ZIP mde)
Date (monm. EaY. Y��)
Date (mmlh. tleY. Y��