HomeMy WebLinkAboutMortgage_Tenbarge"'� STATEMENT OF MORTGAGE OR CONTR�jf I�D�BT�� Coun Tovmship vear
_ s FOR DEDUCTION FROM ASSESSED VAL11ATlp��
• State Fortn 43709 (R11 / 6-09)
S,«. � rresv�oee ny oeparv�m ��i cwemr�m Fu�ance $ E P j s Z � � � File Mark
wsrRUCnoNS: ^
To 6e filed in person or by mail with Ihe CountyAuditor or Counry Recorder o/ the �� ilnty w roperty is bcated, F� ��
Filirg Dates: 1) Real Property: Must fi/e dunng fhe year (or which the deduction is sought. �unty Auditor
2J Mo6de /Manufactured Homes rrof assessed as Real Pr���c�� the phre/72) rtwnths � �unry Recorder
before Ma�ch 31 of each year the deduction is soughG A� I UFZ
See /everse side !or addilional instructions arM qualilrcataons.
n.-s�,�a��r��enYasw M�
Ma'd�7.armntyPar Metd
If m. what is lus ! twi e�pq yw¢ OI Nterest'+
If rwne an �emd is 6Rer�t ilun Nat of appGfanf, iMic
Name of nprtpagee or mntraa seDer
Addres W rtnrtgagce or contract seDer (nem6ri ard sb
Name of assignee or olher oxner w htlder W rtprtgage
AdErew o1 assk,gice (numDer arcl shee;
v�cenr i^ aoy omer
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I/ We certify under the penalty of pe�ury that t/�e above and
owner I contract buyer of the aforementioned pmperty nn da
� �g:.,_ : _ q. ,�,�-
1\. FW revCent atltlr¢ss ol appfirant (number and shee4
e„ �� �,.,-,z-0.�
Pddress of author'ved person (num6er aM sbee; ciry. state, aM LP code)
Remrtl
indebicdness unGaid as d
Page
1"ES,1���C7
� P�GenY in question: Mm�aM Asussed
] Real Pmperty ❑ Nmually Pssessed
Mobile Fbme !IC 6
Has Mis deductia� Deen requested m proprJty
tw wrtent yeaYl
❑ Yes ❑ No
�o i zo
informalion is We and correc[ aM Nat the appliran[ is a resident of Indiana a(W
ian is filed.
Date (nwW. daY.YeaA
�6 3
oa�e cmomn. aar rea�
y