HomeMy WebLinkAboutMortgage_Luhring (3)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__._ , FOR DEDUCTION FROM ASSESSED VALUATION
Smta Form 43709 (R77 / fa09)
� ur Presm�0ed by Depanmerd af Lnral Go�emmenl Fuwtte
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wsrRUCnoNS:
Form Ne0 wiih:
To be filed in person w by mail with fhe Counry Auditor or County Recordei of the counry wheie the pioperty is bcated. A G ��, ��, ,,„,
Filing Dates: 1J Real Properry: Must file dunrrg Ne yrear (or which the deduction is sought. ��q�d���
2) Mobde / Manufaciured Homes not assessed as Real Property Must fiie dunng fhe M1velve (12) months
betore March 31 0/ each year the deductiar is saqht. ❑ Cou^ry Re°°rdu
See reverse side Citiunal ins and qualifications. ��' '�
MW��! .I /f"�i�i A/l�e' d l / � -..�0� CCUNTY P.UDI?OR
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Nartre at rmrt9a9� a conUaU sellei
tr�G'uate beb�r.
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Addf�^ af fllOfi�MJ¢C Of fLflNdCi 3Wnl (ntaMel and SbBeG �/N. S18fi. HIC LP oDCB)
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Name of 255ignee of oihet aM�et ar halda of mrtgage
Pdtlress ot ati�signee (num0erarM stree4 �: smfe. end Z/P cade)
Ooes aPyimnt own property in a�ry otlur If yes. what countyt VYhat Tad�g
counryinlnd'ena? ❑ Yes-
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�-� - - -
: ot aOP�� legal or eWifade on+�el1
❑ Yes ❑ No
someorre atlrer than spouse. ird'�te Wfi w�om
Is tl�e O�OertY in Ouestion: Mnua➢Y AsessM
❑ Real ProPeAY ❑ Nmually Assessed . . .
Has Nis tleduction Deen reQUested m P�Y
for wnent YPaR ❑ Yes ❑ NO
20 � 20 _ � 20 _ � 20
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Ca� � 1 Counry Date (montlr. daY. Y��
� .,.,ry that the a e and foregang infortnalion is true and cortect ark that the applicant is a resident ot IMiana aM
. a�ekmen' pmperty on date application is fiied.
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Person auNOiaed by duty earecuted Power of Attomey w Ey IC Gt.1-12-0.7 Date (montli. d2Y. Y��
Pddress ot auUmr'ved person (number aib sbael, cdy. sbte. and LP cotle) .
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