HomeMy WebLinkAboutMortgage_Massa""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Courc
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
. . Slate Fortn 43709 (R11 / 6-09) �
� Pmsaibed by DepartrtreM af Loml Gwemrtrent Frexe
�«.
INSTRUCTIONS:
To be filed in person w by mad wifh the CounryAuditor o� Counry Recnrder o/ the county whe�e the ploperly is located.
Filing Dates: 1) Real Proparty Must 6!e durng Ne year for which the deduction is sought.
2) Mo6ile / Manufactured Homes not assessed as Real Property: Must file dunng Me lwelve (12J months
be/ore Maich 37 o/eacA year the deducGOn is soughG
Sea reverse side fof addrtional insfilctbns arM qualifications.
(ownermoopvaa4N'�r-seere5victionsmrerersesitle) _ y�,� Il
rc m. what a h"s � nu euG share of int�sta
u
mortgagee a mntract seller ^
L
of rtaRqagee or wntraa seAer (number and
Nama of assignee w oNel owner or hdder o1 mortgage
Mdress W assignee (num6erendatree4 �1: s7ste, am
Mant axn
InEgna?
��
0
aw'red wiN someare olhg than sPOUSe.
ZlPcade)
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� 6o�frd¢j�ditor
❑ Counry Recorder
""�'� � r AUDI70R
num6er Page numbu
Is Ne eppfrcant the e
kgal a epui1a61e owneR
n Ye5 ❑ No
P�CenY in Vuestiav MrweDy Assessed
�I ProPeKY ❑ ����Y �
. Modle Fiortie fIC 61.
Dra�ti�er NO...IXQ��......
Card \�o. ...309�......... -
� I �S,000. aD Y
� �i n�'i'or�„Q �� -
20 _ 20 20 20 _ 20 20 _ 20 _
Sigfunrte d CamN Aueiwr Caunry Date (rtn�vh. daY. Y��
I/ We cerofy under Ne penalry of perjury Mat the above arni foregoing intortnalion is we and correc[ and that the applinnt is a resideni of IrWiana and
own�l contraU buyer oi Ne afaementioned property on date appiication is fited.
Sj�a ownars (u0 narry9 _ � A _ Date (month. daY. W�+)
person autlq�¢etl Ey OWy rsewteO Power o(Atforney w �y IC 61.1-12-0.7 I Da[e (monfh. deY Y��
Address of aW�oi¢ed person (number arM SLee4 �Y. �+a. antl LP Code) . ' _ _ _' "