HomeMy WebLinkAboutMortgage_Overline"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
�__ � FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R71 / 6-09)
ti,,,, � PresviEeC M OeGa�ru of Local Govemmerrt Finarce
INSTRUCTIONS: ortnp
To 6e fiied in person w by mail wiUr Ure CountyAUditor or Counry Recorder o/ fhe counry where the property is located. F N I 1� �� 2 � � 0
Fifirg Dafes: 1) Real Property: Musf file durirg the year Ior whirh the deduclion is sought. � L j Counry Auditor
2J Mobde / Manufac2led Homes not assessed as Real Property Must h7e dunng the hvelve (12J months
6eloie March 31 01 each ysar the deduc7an is sax�hL � �^ �� �
See reverse side !or adtlitionaf insuuctions arnl qualifications.
Mortpage / Contraa int
Mard�t arrentyem
ny'%
dl
Name af tmtgayee n crntracl se0er
Nama of azsignea or
ditant own poperty in eny oNer
Inaanal ❑ Yes
❑ No
Draumon appfo�ed in tlre amourv af:
ri��
Sig�anne d Camb nuattor
sbee4 �N: sfafa/$lM LF
U
3��1 l /(.�
nC LP code)
If yes, what muntyl
20 _ � 2(1 _ � 20
�_ooa. io�_oa�
unpaid as of Mortgage I Contraa i�Mp�Me�ne
somevrie
��
i� � o
as of Is Ne
legali
�a
iitade owne(.�
Yes ❑ No
1¢ 7�GenY ill Ct1ESLOPI: MfY18q' ASSGSSCd
Real ProPeKY ❑ ��Y �
W�at Tarin9 Oistrict? Has Ih6 deductim Exn 29uesreE m pNputy
forwrteNYeaR _n_-.�'—
�uom Dra��'er NO....•°.�� �...... -
Card NO. ..... � � � �.......
�]C�j �Ui�
c°"°H I
I I We certify uMer fhe penalry of perjury that Ne above and foregoing infomiation is �,.� a� �u comea and Nat Ne apDtinnt is a residerrt of Indiana aM
owner I contract buyer of Ne aforemerrtioned properry on date application is filed.
Full
sfate.
Dale (rtimfh. QaY.
AECress ot auNOrveO De� (n�mbe� aM.weet �% state.
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