HomeMy WebLinkAboutMortgage_Deen_^'n STATEMENT OF MORTGAGE OR CONTRAQjI�IN�E�E� Coum
FOR DEDUCTION FROM ASSESSED VALIl1�TI
• Sfa[e Fam 43709 (Rti / 6-09)
.' P`�°`°e° �°�"e" �„°°' �""�� F�"`° N OV 1 5 2011
wsrRUCnoNS:
To be filed in person w by mail with the Co�ntyAUditor or Counry Recorder o( fhe wCunt'y e e p rty is located.
Fil"mg Dates: 1) Real Properfy Must file durirg the year for which the deduction is sought.
2J Mo6ile / Manufadured Homes rat assessed as Real Prop��l�i`a������ �� months
6efore March 31 of each year the deducfion is sought.
See reverse side (or addiWnal inshuctions arM qualifications.
�y
�vdWedrealpopertyasof e/GOnC
1 t. aarent year 'w� rr� e
T�
II m. w�at's his / her ezact share of intrlest?
If rwne on recatl's dMwatl than that of appGcant. uNipte Eelmr.
Name ol mort9a9� «mnvau se��er ( 1�
1
ndetess d rtnrtgayee «oono-aa seoer (n�rrierJ ard snee ' S
Name of assipiee w otlrer ovrt�er m twlder of mortgage
Ad025s of assignce (number aM spee4 �Y. �fe. artd Z/P mde)
Does ePdifaM rnm P�PP«Y in any oNer —...—._
counryinlndana7 ❑ Yes ❑ � -
Dra�ver NO...��� � .,...,,,
Card lvo. ...5�?.!�a........
zo
Year
File Mark
Form file0 wiih:
dCountyAuditnr
❑ Counry Recorder
L _ , ^ ��Vl� RecoNnumCer Pa9e y�
/1�11' 1 /
(/LLCJ� O� �7
ss unpaid as o( Mortgage / Contra[Y indeb[edness unpaid az ol Is Ihe applican� Ne 5oie
date M appGntion kgal w eQUitade avnel/
� ❑ Yes ❑ No
H owned wiM somea� wher �han spouse. iM"rate wMh whom
Is tM poperty in question: MnuaOy As.xsse0
❑ Real RoPenY ❑ %��Y �
MoWle Fbme (IC 61.1=.
appmved in Ne artwunt of.
.-�
I/ We certify under the pe�lalry of perjury
owner I contracl buyer of Ihe aforementi�
rta 1 lSfiNnamel •
e arid fc
on date
Has Nis deduGion been reqursteE m piopeM1y
�fWRe^��' n .,__ n
.;��
�
is We and correc[ and that the appliran[ is a resident of IrMiana and
Date (rrontli. daY. Ya�
aW�a¢eE Gy dWy execu;etl Pw�er W Anm�� by IC 61.1-12-0.7 I�(��. �Y•
s af aNhaaeE pe�son (nurtibermM shee4 �t sfafa, and LP cotle) .