HomeMy WebLinkAboutMortgage_Risinger^'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS � Coun ip Year
-.--..
; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 43709 (R77 / 6-09) • `� 3 1 ZO''1
,' � Prewibed by DepaNnenl of Lxal Govemmenl Frence
�� C.�,n File Mark
sTRUCnoNS: _ �.
Fdirg Da es � Real Property: Must file dunig the�year � whichRfhededucL'onei ��yh�ere the piope�ry�� �cate�dVUNT A C},,$unry Auditor
2) Mo6de / ManufaUured Homes not assessed as Real Pruperty.� Must file dunng the twelve (12) months
6efore March 31 ot each year the deduction is sought. ❑ Counry Recorder
See mverse side for addilional inst�udions arM qual�cafions.
d rnal pmpaty as of
M2�rh 1. yp2r
It no, what is his ! her euct share o( interest?
QIrt2Ill �/C9f
� Qd �
It `wne on remtl is Nflemnt Nan that o( aPP�^�. ��� �bw.
mon�agee a
• • ,��T�
Recortl number
�
kg31 W EGU�IdhIC Oxf12(�
Y� u No
If owned wiN someone oNer Ihan spouse. iMi�ate wiTh whom
Is Me property in OuesHOrc MnuaOy AsusSeC
�RealProPenY ❑?n!�!�N�
Md�ess o( rtnrtgagee or contratl seller (nvrti6er arM stree4 �y. sbte, arN ZIP code) .
Name ot assignee w other owner or hdder of rtqrtgage
AilCress oi asvgnee (number antl slreet �rtY. stafe. and ZIP code) , `[^' 11
� ' ,l/' �', .`........-
Does e m own m an other If D�"'1��� C � \ O•
VW� WoP�Y Y Y�, what councf.� �irsteE m property
muntyinlnCia�? I ���
❑ Yes ❑ No 1 r� ❑ No
UC ......... Yes
\ Ois rn COUN
C:II'CI �� . ............
DeducBon app�aved'm ihe amount ot
�
SyraWre d Counh PuCimr
20 _ � 20 � 20
Counry
20 � 20 _
Dale (mOnfh. daY, y'�a�
20
I/ We certify urWer Ne penalty of perjury that the above anA foregoing infortnation is We and correct arW Ihat the applicant is a resident of Indiana aM
owner / conVacl buyer o( Ihe afo2mentioned property on date application is filed.
I^at/ul? (ownefs/�fiAI riame) Data (monrh. daY. Yge�
` 1 ,/� A �Y �'� .�`Afli /Y�•tlil. � � � � — ��
FW resident a0dress of appfwant (number arM 51�2( ary, srdte, antl
� 13G7 �. Gmxtidr,�a C+. �
Person autho�rzeE Ey tlily ezearted Power o( Anomey rn by IC 61.1
person (number aM street. Uy. sfa(e, antl ZIP code)
l,i�/� �i "i (a 3 �
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