HomeMy WebLinkAboutMortgage_Lingafelter"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun�
._, = FOR DEDUCTION FROM ASSESSED VALUATION
�• Stata Form 43709 (R71 / 6-09)
�' J PresoibeE by DepartmeM of Loml Govemmer�l Fuvnce
w.
wsrRUCnoNS:
To be �led in person or by mail with the CountyAUditor or Counry Recorder o/ the counry where the pioperty is locafed.
Fil'ng Dates: 1) Real Property: Musf file dunng the year /or which the deduclion is soughf.
2) Mobde / Manufactured Homes not assessed as Real Properly Mus! Ae during the tweNe (72) rtwnths
6efoie March 37 of each year the deduction is sought.
See revecse side (or addifional instructions and qualifications.
iv U/'o�J- a�—
p�operry as of Mortpage / Contrati in
Marr3� t, wrtent yeer
18i 6�115 � hE! B%d� 5�12l0 Oi V1iCR5t�
m�emrE is dMerent ihan that of aPP��l inEiqte Celo�r
Nama oi nxvtgagee «mntraU seAer
address ot rtnrtgagee or mno-aa seo�
Name of assignae or othu owner or h
morigage
AOCress oi as9gnce (nurwer em sviceG my. s+are, am ur coae�
Oces applimnt axn yoperty in any other If yes, whz
munry in Iberial ❑ Yes
❑ No
I•^IT•�^l
20 I 20
Sigfatu�e U Cotmfy AuEitor
I I We certi(y uMer the penalry
owner I contracf buyer af th
Sig (o s na
� F � ent W a (nyj
- v — a
s unpaid az ot Mortgage / Contrar� uW
tlate of appGption
If ovmed with somearie aher Iha
GPDP.Y�'l_LIULLli
wrcn: ----
�o���d"rtor
Counry Recorder
ebtedness unpaid as d Is Ne app0lrant tlie sde
legal w equltade wme(+
❑ Yes ❑ No
n spo�se. indimte with �vtwm ,
Vq
Is e praperty in Quesuon: MnueMASSessed
Real PfopeRy ❑ AmvallyASSe�d�
Modle Fbrtie �r_ -
L �O � ��.
1 p\�' C
�. 'SqSq ��...
C�'�\�• "� �
��aq �� ° � No
20 20 20 20 _ 20 _
Counry Date (month. daY. Y��
Nat Ne ahove anG (oregoing information is We and cortect arW that Me applicant is a resident of Indiana afM
ned pmperty on date application is filed.
Date (rtw�th. daY. Y��)
Oy duy exewted Power o( Mort�ey
Pdaress of aWiartrrd pe�son (num0er aM sLee4 �y. sbre,
.daY.Y�� - �-