HomeMy WebLinkAboutMortgage_Conklin^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ • FOR DEDUCTION FROM ASSESSED VALUATION
..• StateFOrm43709(R77/6-W)
�` f Prestri6ed Ey DepartmeM of Local Gwemment Fnance
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INSTRUCTIONS:
To be fifed in person or by mail with fhe CountyAUditor or County Recorder ot the counry where the property is located.
Filirg Dates: 7J Real PropeRy: Must file dunng the year /or which the deduclion is soughL
2) Mobde / Manufadumd Homes not assessed as Real Property Must fife dunng the hvelve (72) months
6efore March 37 ot each year the deduclion is saght.
See reverse side /or addi(ional instructions and qualifications.
Ao ow�eerwcontracl6uyer-see mreverseside) �„ � � ' i�il
1 vaWe d rea17�P�Y a ot
aa�e�a ymr
Itis I her eraG share of inteJesl?
If name m�ecortl's diflurn� lhan
PR�ij 9 ddld��wd���
n n-.•Counri Remder
N COUNTY AUDITOR
er / kgal desaiGtion Remrd number Page numoei
-,�a_o3-/oo-oov. g�P-oa5� �-o�� 3�'v
A1pr(pyge1 Contraa iMehted�ress unpaid as U Mortgage I Contratl'vMebteAnrss impaid as d Is Ne apd�t the sde
Mard� t, arrent year date ol appfiotnnp �egal or equilade ovmeYl
p S � S� ❑ Yes ❑ No
If ovmeC vriM mrrieone dher Ihan spousc. IMicate wM wfwm
lt. Rldl(2S8 bC�OW: �5 pIC PfOpCIIY 111 QYESLOfI: iV11W2�`f ilS5C5fifd
❑ Re� Pro�rty ❑ nfmuany�sud
. _ . ._ _ a�obae r+ome pc 6�.� �
Nartre of mort9a9ee « mntract sener �
contract seller (number end sbeef, cGy, state, aM ZIP coCe)
omer owner or naoer rn morzga9e
__.�_ �T �, w , _ �
pp¢y aPP��^� �^ P�7�nY �^ any oNer
munry in Ird'ana? � Y¢5 ❑ No
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DeEUCtion approved'o� the amount at
20 _ ZO
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20 I 20 I 20
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Card NO[''�./' �.....!.����\�.�.......
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ii25Ii1L5 dfdU4�1N1 DEPlI RQllq�c� v� NNT v
t�W�� ❑ Yes ❑ No
2q — � 20
inawre a CamN nue�mr __ I Counry � Date (man�h, daY. Y�� —
C - T.
I I We cer4fy under Ne penalty of pe�ury t the above�foregoing infortnalion is We and oortect arW Nat fhe applicant is a resident of Indiana aM
oxmer I contracl buyer ot the aforemeMioned property ate application is filed.
7iu wneh futl na// //. Date (mmth. daY. Y��)
i ] /n
(number antl s1n.�e4
Pelson auunRea oy dWy ezecutea Porer oi Attorney m by IC 67.1-12-0.7 I Date (monm. daY. yea�
Pdtlress of aWmr@ed person (num6erarM stree{ firy, sbte, end LP aode) .