HomeMy WebLinkAboutMortgage_Ridens^'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
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FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 43709 (R71 / 6-09)
� PresviGatl by Department ol Laal Govemment Frence
�STRUCTIONS:
To be (led in person or by mail wiN the Counry Auditor or Counry Recoider of the county where the property is located
FAing Dates: 1 J Real PropeRy: Mus! !le durirg the year for which the deduction is sought.
2) Mo6de / Manulactu2d Homes rrot assessed as Real Property Musf fife during the fweNe (12) rtwnths
before March 37 of each year the deduction is sought.
See reverse side (ol additional instructiw�s and qualil'ications.
Appfxanl (qwner orcontrarf buyer- see r�ttn'20ons or�reverse sida) � �
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A�{eSSeC rahe of real poPertY as d I hbrtgage / Cor
Ma(d� t. qnpnt ypar Martl� t. wrta
II ro. what "s tus / her e�ct share af interest? ..
11 name m mmrtl rs CAleren[ Nan ihat of appG�an4 ��m� bebh'
w cantract seUer
Name of assgnee w aher ovmer or hdder of mortgage
Coun Auditnr
�� Recorder
� oo -oov• 9oq -o a�I Rem�d O Pagen�
aa'uWebteCness unPaid as N 0.fortgage / Can�'u�0ebiedness unP�7 az d Ls Me ap�t Me sde
v� date of appfimtm kgal ar equitade wmeR
� � �. � l) % ❑ Yes ❑ No
S. 8,
state, aiM LP cat
ACCress oi as56gnee (number aM stree; ary, sfafe, aM ZIP catle)
T SF_ 3 3_ 3-i/
Does appMant am propeM1y in any dher If yes. wha[ munq?
ca�h��i�c�a � .. r, _.
Detluction appmved in Ihe artaunt of:
zo � zo � m_
s�y�an,a a
I/ We certify u�er ihe penatty of pLrjury Mat the �6�
awner I contrad buyer of ihe aforemerrtoned Propert}
'\ /1 1���'1( tA�J�CL� I( � W
ol add'xant (number aM
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sumeore other Inan spouu.
I5 Me property in puestion: Mnualty AsesSeC
❑ Real ProPeKY ❑ %���Y�
MoWle F�brtie fIC 6
Wf131 Idlllg UISfM'� %
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COUNTYAUDROR '
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( �n � ��, �,:,�n
e aM (rxegoing intortnation is W e and correa ard Ihat Me applirent is a resident of IMiana aM
On date appliqlion is filed.
, oace pn«m,. ear. rgen
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Person autM�rzed Dy duly esecuted Power UAtlnney or IC G7.1-12-0.7 Date (monlh. tlay. yea�
PdCi¢ss of auUmrzEd person (numcera�d svee4 ary. state. end LPaocle)