HomeMy WebLinkAboutMortgage_Miller (20)-,
�
^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS co I vear
__ � FOR DEDUCTION FROM ASSESSED VALUATION
• Sfale Fortn 43709 (R11 / 6W) ZO„
•�' ,,,, � Presnibetl by DepanmeM of l.ocal Govemrtrent Flnarxa �
File M
INSTRUCTIONS:
k 6e filed in person or by mai/ with the CounryAudita or Counry Recorder o( the couniy where the property is located. F� ��
Filirg Dates: 7) Real Property: Must h7e dunng Ne year for whi�h the deduction is soughL �1Ny,� f��
2) MobBe / Manufactured Homes not assessed as Real PropeRy Must file dunng the twelve (72) montliO�BS N CSLY
6e(o�e March 3f o/eacA year the deduction is sought ❑ �^b R�bw
See reverse side for adddional instructirons and quali�cations.
what is ha / her e�ct share of interest?
r/ kgal desdiption 1 Record number Page num�ba7
Io-ZZ—O� O 'O�C /� �L 1
e/ Contract iMehtedness unpaid a d Mongage I ConvaG uWebtedness unpaid a o! Is Ne appfxant tlie sde
Ma 7. wrtent Oate o( appGCaUon tegal w eduitade owne(?
��j � ❑ Yes ❑ No
Ii owrred wiN sameorre dher than spouse, iMicate with whom
If name on recnd is E'fie�art than Nat o( a0P��4 �dlnte Gelow.
�� o� ���
oNrs owner rn halder M mortgage
AdCress ot assignee (number aid streeR �y. s+afi.
� ObOenY in puestm: MnuaDy A,sesud �
� �oaenv ❑ �,n�ua�N w�sed
Mowie � nc s-�
cdy, sb.e. aM ZlP codel n � M ,, �
I� fYi /1 � � ��(�(�
.,wy� ..
0
� 1 / / _ / / P
Dces appli�ant ovm property in any oNer If yes, wfial munD/T YMaI Tabrg y
munry in IMiana? ❑ No �
n Yes