HomeMy WebLinkAboutMortgage_Phillips"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_,. � FOR DEDUCTION FROM ASSESSED VALUATION
Siafe Fwm 43709 (R71 / 6-09)
S t PreunLeE M DepaM�eM of L.o� Govemrtieru Fwnce
� Fil
INSTRUCTIONS: �
Fam :
To be filed in permn w by mail wifh the CountyAUditw or Counry Recader o/ the oounry where tAe poperty is
Fding Dates: i) Real PropeRy: Must ke dunrg Ihe yearlor which fhe tleduclion is soughG Counry Auditrn
2J Mabde / Manufadured Homes not assessed as Real Prt�perty: Must file d�nng Me fweNe (72) months �,�q
6efore March 31 of each year the deduclion is swght. F E � ��tv�' R��
See reverse siCe for additiWnel instnxtions and quelifications.
e� .» I .....h�.ti n.�.n.. em m �'v»ea ww.hiew eiiwl . � .. • ._ � i/
— vur�—
As�ed vdue of 2al P�P�Y ffi d
Marrt� i, a+min year
tt rm, whal is h's I her erad sliara
name on remtd is Grtte�sn tlnn
«mntrari se9er
unpaid
Mdr� of mortgagce u mntraG seAer (number end street �11: stefe. arM LP oo0e) —..
Name of assignea w oNer owner w halEer of mc
Drawer \'0...���.�.......
Address of assignee (number aM stree4 �y, s+a
Does e�imnl ovm property in eny oNer
countyin InGiana? ❑ r
❑ Yes
Dr�uUm epproved In �he amount oF.
20 20
Sig�hire W Co�mb Audttor
I I We certiy under ihe penatty of perjury
r I tontract buyer �' afo2
��ue xrieYSfiiO
F iGent a d o pl' t(numDe� sl
rJSOn auN etl Oy dWy ezecvted Pwer of Att
AdAress d autha've0 person (number aM sbec
cara r��o. .... y y.� ........
�1Qi���U.�R�
20 _ I 20 _ I 20
s udebtedness �mpaiC as d� 4s Ne appOCanf Ne sde
legal a epu(tade owneR
❑ Yes ❑ No
r Uan spouse, uM'�te with whom
Is Ne poperty in qurstion: MnuaDy AssesseO
❑ Real ProPertY ❑ ArmuaDyAssesud
0.loble Fbrtie QC 61.1-7
Mes Ihis de0uc�on Eeen reVUesteE m properly
(or W�rmt Yea(t ❑ Ves
❑ No
2p 20
Date (nmCr. EaY. Y��)
Nat Ne above ard foregoing informatlon is trve and cortecl arM fhat Ne applicant �s a resident of Indiana aM
�perty w� date application is fiied.
%�' Date (rtnnN. deY Yge�
dry, sfate,
5fata, antl ZIP Cod9)