HomeMy WebLinkAboutMortgage_Juilan"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
• Sta[a Fortn 43709 (R71 / 609)
S Presmbed by DepartmeN ot Laal GovemmeM Firems
� File Mark
INSTRUCTIONS: �,���J��
To 6e filed in person of by mail with the Counry Auditor or Counry Rewrder o/ the counry where the ploperry is locat
Fi7ing Dates: 1 J Real Properry: Must fiIe durirg the yearlor which the deduction rs sough[ � n.AU itor
2) Mo6de /ManulaUUred Homes rwt assessed as Real Property: Must h7e dunng fhe hvefve (12J mon
be(ore March 37 ot each year the deduction is sought. _ County Remrder
See reverse skle for dd� " al instnctions and oualifications. l,
Key rcanber
f rahre d rnal prope�ty as al
❑xmntyP2r
�i M. W�12� 6 �16 � h2f G12C15�1df8 Oi Ill}CIESI��
Mortpage / Conn
Marr}� 1. artent
name on rerorE is different than Nat o( aDP��4
u.:�.--" •�uZ7
of rrort9a9ee or contratl seller (number and street cey: state.
Name at assignee w othel owner or halder of rtqrtgage
AdC25s ot assignee (number aM atreet, cdy, s�.
any oNer I If yc. what counq? ,
r-i .. _
SOff12Mf
What Tarirg D'avicf?
L_'�
as of Is Ne epd��� �e sde
legal or equitaNe ame/7
❑ Yes ❑ No
Can spouse.'udi�te with whom
Is Ihe P�Pen1' in a�es�: �nually Assesud
� Real Property � NmuallyAssessed
repuested at pfopetiy
❑ Yes ❑ No
ducUOn app
�1•�\1'�l. \Q.... . .....
20 _ � �O �( 20 20 _ 20 _
� Card �O. ...�.a�g� •�r�.d'I `}�
ca,�,h oa�e�� V�V G (�(
.
i
I I We rtify .._.. N�e penally of rjury t ihe above a foregoing infortnatlon is We and correct arM Nat ihe appliran[ is a resident of IrWiana and
n buyer of e mefrtioned property on ate applicatlon is filed.
� ve re SA.0 r Dale (rtmtl�. daY. Yaa�
ent W appGCant (nu 6eraM sbae( tlry, stafe, and
7 !ll � D s S' �bN�
auNa¢ed Oy duy eaxwted Fower o(Anomey or by IC 67.1
pnsan (number aM saeet. ary, sfate. and ZIP mde)
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