HomeMy WebLinkAboutMortgage_Meny (9)^�� STATEMENT OF MORTGAGE OR CONTRACT INDI
__ . FOR DEDUCTION FROM ASSESSED VALUATION
• Slate Form 43709 (R71 / 6-09) .
�' w� PresaiEed M�.`Parnnetrt o1 Lotal GovamrtieM Finance
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INSTRUCTIONS:
To be (led in person w b mail with the Coun Audifw or Coun Recorder of the cnun where the rs located. F�
r N N b woae�ry' �77
Fitirg Dates: 1J Real Property: Must file dunrg fhe yearinr which Ne deductbn is soughG n � nty Audimr
2) A1obBe / Manu/aUUred Homes not assessed as Real Property Must h7e dunng the hvelve (12) ��N C �r,�i p pITUR
6e(ora Mamh 31 of each year the deducfion is sought. ' LJ �nry Recorder
See reverse side for additional instniUbns aml qualfiwtions.
MP��� (ow�rer o� mntraU buyer- see rewictons m reverse side)
Key nimber I kyal desaip R¢cortl number Page wmEe1
�.�t a�-i�-3 -�oy-000. Sa.3�oo9 0 0 3�1
poper,y az of Mortpape / Contrati inde6ted�s unptid as N Mortgaga / Con�'uNebteCness �mG� as d Is Ifre e0�1 ihe sde
Mamh 1. ar��Q� appfration kpal
U� O� ` date of «epuita6le oMmmY/
U ❑ Yes ❑ No
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Name ot rt�ortgagce a mntrari seDer
Address of mortgagee m m�trad se0er (numbu end streef, ctiy, �te, aM ZlP code)
Dces epplitant am property in arry i
munry in Indana?
❑ Yes
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sy� m c�,ry a,a�
sfete,
No
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Yes. what munt�/+ Wtat Tadng DatrH?
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Ma5 iha d¢EuC60n Ee2n requested m ptqrny
forc�umn�YeaR � Ves ❑ No
�-� Noc�s =
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I I We certify urWer N�penalty of perjury that
owner I contract buyer of Ne ataemeMbned
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e and (oregoing infwmation is true and carrect a�M that ihe apphn�i� u_. ,iara and
on date appliption is filed. �
oa� �,�,o�m,, eey, ree�
state, end LP mde)
(monlh. daY. Ya�/)
AdOress W auNarsiW 0�+ (numberaM rnee4 �l: sfate. aM LP mda)