HomeMy WebLinkAboutMortgage_Ambroseti� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
.__ _; FOR DEDUCTION FROM ASSESSED VALUATION �
Stata Fortn 43709 (R71 / 6-09)
�,�,. Presaibetl by DepartmeM of Laal Govemmerrt Fuarce �
File Mark
INSTRUCTIONS: II r q
To 6e filed in person w 6y mail with Ne CounryAuditor or Counry Rernrder of Ne counry wheie the pmperty is IocaY� �� �� �
Fitirg Dafes: 1) Real Property: Must file during the year fir which the deducUon is sought. � Counry Audimr
2) Mobde / Manulectured Homes not assessed as Real Property Must file during the twelve (72) mont
6efore March 37 of each year the deduction is sought. �G� �� �+nty Recorder
See 2verse side 7or add"Rional instnictbns erid qualifications. /
r,iasON COUNTY AUDIT
a�¢sea vdue a rm aopeny a m
AIa�U t, a+�en[ )ear
rc no, wt,at Ls n's � trel e�a share or mtemst?
-i�- 3OQ -00% � 4 3. o a �_._d.� o� y�8�s3
i I Contraa indebtedriess unpaid az U Mortgage / Contrac2 uWebtedness unpaiE as o( Is Ne eppi'imnl Ue sole
�nt year aate of aDP�� legal or eQUitable oxnrl/
� D Q Q� ❑ Yes ❑ No
If owned with mmewie aher ihan sPa+se.'udkate with whorn
1f fwrre m �emrtl e Sttvm�t Nan ihat of aPpOmn4 hMirate belox:
Nartre o( mortgagee n crnvaG seller
Add2a of nwrtgagce or contract seller (nwru
Name af assignee w dhu wmer or hdder ot
MEressotastigm (numberantlatreef,cdY.
Dces applifam ovm praprlty in any oNer
cwnty m Intlana? r� _. r
SignaWre o
1/�
ownerl
re�
� Fup ' en
� aW
AOdress d
20
�/3
ier and sLeeL ciry. s+ate, aM ZIP code)
mortgage
578te. en0 LP ootle)
� 2t�� /S
I( ye5. what munt�/1 What Tarin
No
COUNTYAUDROR
20 � 20 _
Counry
Ne penalry of per�ry that the above aM foregoing infortnaGOn i!
Id uyer of the aforeme�rtioned property on date appiiration is filed.
NO re )
P,' %di ,a,r��r
ss o( a cant (num6er and stiee; tiry, slste, antl ZfP oode)
�'�.�.T�d p r_ t1 Q_ I-la «d � l.�J� .�
Oy duty esewted Power of Anmrey w by IC 61.1-t2�.7
Ge� (num0er aM sbee4 dN• 5lale.
'�O�Pert1' in purstion: MnuaDy Assesse0
Real Property ❑ Mnually Assessed
Has Nis tleduCia� been repuested m proprlty
tar wrreM 1'eaR ❑ Yes ❑ No
D1':111'CI' �'Q. �:.� � G. — —
Card NO. ...:?�S�
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