HomeMy WebLinkAboutMortgage_Osborne (2)°'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
SIffie Fortn 43709 (RB / 2-07)
�' ,,,, � Presmbed by Oeparlmenl ol Locel Govemmart Firance
F ark
INSTRUCTIONS:
Ta 6e filed in person or by mad with the CountyAud'rtorW the aou�y where flre pioperfy is bceted.
f&'vmg Dates: 1 J Reel Property: During the 72 months 6efore June 17 of the year the deduc6on is to be e9ecGv�p g p 7 2009
2J Mobile Hames essessed rmder IC fr1.1-7: Belween January 15 and Ma�ch 2 0/ the yea� the d uc6m is to be eBective.
See reverse side /w addiGonal insbuctions a�d qualifications.
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AppicaM(ownelarwn(rad y�r/$ fe � .._ � n. n �/..-_.. ..��nITOR
,.�e et re� pape.,y as a htamh ,, a.re�a,rear
m record is AiHerent Nan Ihal of appliraM, indicate 6elar.
Name ot rtiatgagee or mnuad seller
Address of rtaAga9ee or oonUaC
Name
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❑Yes ❑No
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❑Yes ❑No
olher Nan spouse. intlicate with whom.
Is Ihe propeM1y in qucstim:
❑ Real Property ❑ Moble Home QC G7.1
20 _ � 20
Data (month. daY.
uested an p�opaly
❑ Yes ❑ No
20
I/ We certity under Ihe penalty oi perjury that the above and trnegoing infomiation is We and corred and tliat ihe applipnts was / were a resident of
Indiana,�nd owner of the aforementioned property on March 1, 2b _
�tim��,a r.,�..r<nni.wmel il � . Date (monfh, daY. Y��
applicar0. (num6aranEShee1. cifY. sfate.
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AddrrssoFaWUr¢edpasan (numberends4eeLfdy,sfate,afMLPmde)
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