HomeMy WebLinkAboutMortgage_Karges� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_. = FOR DEDUCTION FROM ASSESSED VALUATION
• State Fartn 43709 (R11 / 6-09)
, � Prewibetl trY DepartmeM of locai GovemmeN Finance
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Fi e
INSTRUCTIONS: �AY
b 6e Red in person or by mad with the CounlyAuditor w Counry Recorder of the wunry where the property is locat
Fiting Dates: i) Real Property Must file dunrg the year for which the deduction is sought.
2) Mo6�le / Manufectured Homes irot assessed as Real Pmperty Must file during the hveNe (72) monfh�
be(we March 31 0/ each ysar the deduclion rs sought �
See reverse side 7or addifionaf instructions and qualil�cations �
Mo��l(op�ce[umitrart6uyerri3>�esniraonsan+i side)
i. anetC year
ta h'a / her eratl share o� Nterest?
?3-/�� o- 011v . 9��- O� SL
Mwtpage / Contract 4de6teEness unpaid az d Mongage / Contra
Ma� 7, wrtenl `/Par Eate oi app�tqr
H nane on temrtl ia E'iftuent ihan that W appOCant
Plame M rtartga9� a ronVen
mntraG seAer (numbar and snaet, cdy, sb�. aM ZIP cade)
w dhv owner or halder o1 rtprtgage
nmress m assiq�ea (��m0e. e�d vrret r�: srate, ara z�a arro)
Does epplipn[ own pmperty in any oNer
munry in Indana7 I-'I ..__
�
�- i �- i �-
rc ownm »;m sameone
County Auditor
younry Remrder
Rernttl num6rl Page
0/0 �
unpaid es d Is Ihe aPplira
r� u r+o
Is ihe pope+ty in purstion: MnueM Assessed
�teal P�vPeAY ❑ Nmual�YAs�ed
TT eeow� r�ro� nc 6
repuested m prop�ty
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i I We certify urder ihe penalty of perjury that the ahove and foregoing infortnatlon is W e and mrtect ar�d Nat the applirant is a resident o( IrWiana arxi
owner I contract buyer of �he aforemenUoned property on date applicalion is filed. �-
� owne !u0 name � Date (morvh. de'Y/. Yaah
.. .v i . _ . /. n . ,. . . �, . A /i / � _ / f-L _ �/�
dWy executed Porer of Attamey or Cy
Stale. enC LP cotle)
Date (monlh. tlaY. Y��