HomeMy WebLinkAboutMortgage_Miller (2)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_, FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (R10 H7-08)
�,.�. � Piesaibetl bY ���N�ent ot Lmal GovernrreM finarce
INSTRUCTiONS: � i e MaAc
To be filed in persan or by mad wifh Ure CarntyAuditor d the cainty where the poperty is bcated.
Filirg Dates: iJ Real Pioperfy: Must f2e dunng the yeer for which the deduclion rs sought. � I I N 1- 2��9
2J MobOe / Man�/aclured Hortres not assessed as Real Property: Must Rle dunng tlie fweNe ( 2jmonlhs be/ae March 310l eacM1 year
the dedudion is soug/�t
See reverse
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u �mrr�e on remrd is a�erem uwi uiat m epcti�ant �,aimte ceww:
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Does app�rant wm pope�tY in airy other
muiriy in IMia�7
❑ Yes
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stab. aM ZIP mEe)
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I/ We ce�tiFj uMer tl�{'pe�aity of perp�ry that �above
owner / mntract bufei of iha aforemenlioned rtv o
hAy esecuted Pwrer dAtlomey u by IC 6-1.1-12-0.7
person (nunberantlsLer#,aly,sbfo,andLPwOO)
unp�,gg o( MMgape 7 CmtraG indeMedness unpaid aa d Is the applicanl O�e sda
tOLi dale of appGqtion lepal ar e7uRabla ameR
� � ❑ Yes ❑ No
s7a+se. indi�ata with whan
b ihe P�WeM in Cuestian: MnuaM Assassed
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