HomeMy WebLinkAboutMortgage_Galvin^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Couni
_ ; FOR DEDUCTION FROM ASSESSED VALUATION .
Sfate Form 43709 (R77 / 6-09)
�' f Presaihed by Departmenl of Loml Govemmenl Frence
INSTRUCTIONS:
To be �ted in person w by mail wifh the CounryAUditor or Counry Recolder oI the counry where the property is locafed.
Filing Dates: 1) Real Pmperty Must file during the }rear for which the tleduction is soughf.
2) Mobi/e / Manufactured Homes rrot assessed as Real Property Must fi/e dunng the hveNe (72J months
6efore March 37 0/ each year the deduction is sought.
See �verse side for eddtional insfructions �d qualil'ications.
M�.cant ( r centr§�C buye� � on reve(se S1Cel 0 � O rn$'
d vaNe d rral p'aperty a d Martgage / Cantract'v
1. amnt year Mart�h 1, turtent year
rc �o, rmat ts nis � ner erM slare a interest?
If name on iecord is diftuent �han that o( aOP��l �dipte Debw
Nartre o1 mortgagea a contract uller
mofhjagce W contraG st
ssim�lee or atlrei owner rn
a mongage
Aaaress m assgnee (nurrmer aru sueer, ary, stare, aro ur cooe)
Does eppfirant own poperty in any oNer If yes, what county.�
munry in IMFana?
❑ Yes ❑ No
20 I 20 I 2Q
—(J e�
ir �,m �m ��
vmac raA�q oso-z
COUNTYAUDROR
20 20
RemN m
-CL+�
unpaid as
� �U�p(1{ypu ditnr
❑ CountyRecorder
n equRaWe ameR
❑ Yes ❑ No
ie property in pursiion: Mnually Assessed
Real Roperty ❑ ArmuallyAssessed
1�f��' ��61 r�
� A�vy
u�,-aa5�
20 � 20 _
SignaWre of CounryAudifnr I Counry I Date (rtanN. day, yea�
I I We certify uMer ihe penaly of perjury that Ne above arW foregoing informalion is We and cortecl aM that the applinnt is a resident of Indiana arM
owner I contract buyer of the aforemerrtioned property on date applintion is filed.
Full rehsiEent address ot GappGrant (`numDer an0 streel, dty, state, and ZIP mde)
�dc7o��0 cJOt�'�Yf �rmk �r�vt
Person auNOraed Cy EWy exewted Power of Attorney or by IC G7.1-12-0.7
ACCress af auUror¢ed 7e�^ (number aM snee4 a1Y, 5lafe. and LPmtle)
�i�(o39
Date (monN, day,
I 'Y
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