HomeMy WebLinkAboutMortgage_Maikranz"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
ir"'-
; FOR DEDUCTION FROM ASSESSED VALUATIO� ��
Stale Form 43709 (R77 / 6O9)
i i PreSaibeE trJ �ePaNrieN of Local Govemment Finance
� File Mark
�STRUC770NS: f1�-(� �,rtS*
Pe Y �Y �Y �Y P✓��0 �YN41 Fortn fJed with:
io be filed in rson or b mail with the Coun Auditor or Coun Recorder o7 the coun wh e ocated.
Fifing Dates: 7) Real Propeiry: Must file durirg Ne year (or which tha deducfion is sought. ��Counry Autlitnr
2J Mobde / ManNactured Homes not assessed as Real Prt1peerty Must fi(e durnrgYhe��� ._ Vmonths
be(ore Marth 3f o7 each year the deduction is sought. " ❑ Counry Recorder
Seereversasideloradditionalinstructionsandquali�cafions. ,,,���„ �
(owner u contrdit buyer
���o�
�
Name of mwigagee or mntraU seller
9— 3
7/S
Mwtgage p/ �Cr�ontra1'c�t inCebtedness unpaid as of Mortgage I Contracl irMebtetlness unpaitl as W Is the appli1ant Ne sde
Mamh 1' / / e� O V O� date o( aDP�tion legal O Y25 � No
I If owned wiN somewie other �han 5pouse. iMxate with vihom
PLdress of matgagce w contract se0er (number and 4reef, ciry, state, aM ZIP code)
Name oi assignee w othu owner or
SIREi M: SIdtE,
Does applimnt avm yoperty in any oNer
munry in IMana?
❑ Yes ❑ No
If yes.
I5 ihe property in Ouestion: Mnualty 255e55N
❑ Real ProPertY ❑ Armualry Pssessed
Mas Nis dedudion Eeen reduested on property
fw artent yeal.� � Yes
❑ No
� COUNTYAUOROR
DetlucOm approvetl in Ne amount at:
20 20 20 20 _ 20 _ 20 20
Signa o b Counry bate (monN, daY Y�a�
I/ We certify under Ihe nalty of perju that Ihe above a oregoing infomwtion is true and cortect arW Nat Ne appluant is a resident of IMiana and
owner / contracf buyer of the aforemen' ed property on e appfication is filed.
' nature !s fu0 reme) Date (rtmtl�. day, Yean
Full resident address of apptirant (number antl , ciry, stdte, antl ZI e)
e, s. �-+� a�,..aa�7�G�f z�l7 G 39
auU�d by tluy esecuteG Pow .w of AttomeY p by IC Gt. t-12�.7 I Date (monfh. day, yea�
PGtlress of auNa¢ed person (number aiN sbeef, dry, SYale. arM ZIP code)