HomeMy WebLinkAboutMortgage_Potts� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION � F� g-�
State Fortn 43709 (R8l 2d7) � A—�
S ua � Presrnbed by DepeNrrenl d Local GovartuneN Finance �.••�
wsrRUCnoNS: AFi�R�`�3 2009
To be filed in person or by mad wrth Me CountyAudtorW the county where tl�e propeAy is focated.
Fding Dates: 1 J Real Property: During the 12 months belore June 17 W the year Ure deduction is to be eRec6ve. �/
2) Mobile Harres assessed �mder IC 6-1.1 J: Befxaen January 15 and March 2 of the year the deduc6on is to be e ��,.1
See reverse side lor addrtional insWCbons ert�d quafifications. � ��
- NTY AUDITOR
qpplicant (a�m@r or trarl6uyer - see ieshictlms m reverne sde) .
�J
isVict . Key munber / leyal desalPtion Recard number Page (wmber
-a3-a�t - ao o - b� �- cy.
ralue or rral propeM1y as m rdaid, 1, anent rear M�ga9e � co�vaa u,am�edrwss u,v� as or Marcn 7. �s ihe apW��� u�e sde �eyal or equi�ade ownen
airtera year
� I h/� /1T Q3es ❑ No
� �f M. Wh2115 h15 / hCf C)!2Q 6113I9 O(
m record is
IName
Addresl ot rtaM1gagee u mnirad seller (number and �ee4
Nama of assig�e or alher oanar w hdder of martgage
� Address of auigrree
❑ No
� Deduaion apprwed m the emamt
beIQV:
and LP oode)
I( yes. whel
p� � �- � p- � 2b
wilh sart�eane ather Ihan spoum,
D'atr,
pfOp8ll)' 1l1 QUE511M:
�I P�peAy ❑ Madle Home QC Gt.
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°I � a,. D 5„ �
pra��'er ��•0,........
/ ......
Card N�• ... .. ..
20 2b 20
SigruWre af County Audenr Caunh I Date (rmnfh. daY.1'�� .. •
I/ We certify under Ne penalty of pe�ury that the above and foregoing infortnation is W e and cortect and that the appGrants was / were a resident of
Indiana and owner of the aforementioned property on March 1, 20
Signatwe (mvne/s fiIl�H1� I Date (monfh. deY• Y��
l/1 �.. ., : i.i,1L� v- �4 � 7�7
adent address M appl' (number and sheat dty. sfate. a ZIP codeJ I w' . 1 l,^�
l 3 �9 E ►�j fScY� lA)c�pd�� �n • �S�c�d t � � v �< < �
Parson aulhonzed by duty ecewte0 Po+Rr N N7orney w by IC 61.1-12-.07
Address of aNha¢ed person (num6eiand streef. rdy. state, and LP rode)
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