HomeMy WebLinkAboutMortgage_Andrews"'r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
_ FOR DEDUCTION FROM ASSESSED VALUATION
.. • Sfata Form 43709 (Ri t/ 6-09)
S I pf�p� y�, �yPyrtnreM af L.oml Goremme�ri F�nca
�S7RUCT10NS: i'
be fJed in person w by mai( with the CountyAUditor o� Counry Recorde� ot the counry where the pioperty is located. F�q fl
F�ing Dates: 1 J Real Properry: Must file dunng the yearlor which the deduction is wughL '�p' `�� �unty Auditor
2) Mobde / Manufactured Homes not assessed as Real Property Must fi7e dunng the fweNe (12) months
betore March 31 0( each year Ne deduclion is sought C- i\ i nry Reoorder
See 2verse side 7or additional inshuctions and qualificatbns.
k/
(
ig DistrrcY Key number / legal tlesaiplim Retord number Page numDer
� 2lv-a3- s-3oo-00/� 7-0�- 0 59l0.;
sessed ralue d mal praperty as o( Mortgage / Contract "uWebteOness unpaid as of Mortgage / Convaa irMehtetlness unpaid as of Is Me applirant Me sole
amh t. amrnt year Mard� t. artent year Aate of aoW��+ legal w equitable ovme�
� d 000 ❑ Yes ❑ No
no, what 6 h'a / trer e�act share of interest? If awned with someorre ocher Nan spouse. indiqte with whom
name on tiv.atl is dilfefmt than that of aPP��l "mdinte belaw: Is ihe praperty in 7uestion: MnuaDYAsxesseE
[�'Real ProPertY � �!^�!�N� ' ' '
Name ot mnigagee or mnVact se�er
Add(ess oi rtwrt9agee or contract seller (n�mber and streeG rity, srare,
Name ot assignee or other owner or hdder of rtwrtgage
AEdress of assignee (number antl stree4 �+N. s/ate�. /and ZIP cade)
S� S(� �S' L —�O .O
Does applimnl wm property in any oNer If yes, what counq?
munty in Intlia�?
❑ Yes ❑ No
Detluctim apprwcW u� ihe amount af.
20 � 20 � 20
SigiaN2 of
L- � 1 . r v�
I I We certify uMer Ue penalry of
owner I mn�� buyer of the afor
W
the
snee4 tlry, state,
m
What Ta
cour+n nuurrc
Dra�rcr NO.....�.o�:�......
q �r
CardNO...�.r�� —
........... ] No
�j�0�6�•tx�
20 I 20
Counry
Fi�����1
fiC foregoing infom�ation is We and corteG antl Ihat the applipnt is a resident of IrWiana antl
date appliration is filed.
Date (monfi. day, Yean
P4Cress o( autlra¢etl persan (numbe�a�d svee4 ci�'. sfare. antl ZIP oode)
Date (monfh. da): Yse�