HomeMy WebLinkAboutMortgage_Simmons"'� STATEMENT OF MORTGAGE OR CONTRACT INDE
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
Siate Fortn 43709 (R71 / 6-09)
S�«. P�esrnbed by DepaRmerd oi Ln�al GovammeN Fu�ance
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INSTRUCTIONS: �
To 6e filed in person w 6y mail with Ne CountyAUditof or Counry RecoNer of the counry whe2 fhe property is located. � fl��
Fi/irKj Dafes: 1) Real Property: Musf file durng the year /or which Ute deduction is sought �nly Auditor
2) Mo6i1e /Manu/actured Homes not assessed as Real Property: Must h7e dunng the hveHe (72) months
6efore March 31 o/eaGr year Me deduction is sought �tY R��
Sea reverse side 7or add�6Kn�! inshuctions end qualifications. Q I�90fV
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�i Ibr W�1dI 6 �IR / i1Cf CXdd
If rwrie m remrtl a WRerent Nan that
Nartre of rtnrtgagee or mntraG SeOer
matgagee w mntrad se9ri
r / legal tles��n � � � � M � (d num
��1 �.�l.l aa�-o
Mortgage/ ContraU ind rress u�np7aid az of Mongage I ContraG irWebtedrress unpaitl as d
Merch 1. artem Y�I �� l�7 date ot avP��
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DoNS appticam o.m pro�w��'� �1
counry in IM�� -- 1 � . . . ..
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WhatTaang D'atrin?
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Der Page pu�B� ^ —
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Is Ne eppGmnl iha sak
legal a equRade avmrfl
n Yes ❑ No
Is the property in puestion: Mmu
❑ Real Property ❑ ANlual
Moa7e
Has Na Mtlurlion Oeen reQueStLM on propv[y
far aufent W,af.+ ❑ Yes ❑
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1 I We certify under Ne penalty of perjury Nat Ne above arW toregoing infom�ation is We and cortect and that Ne applicant is a resident of Indiana and
owner I mntraa buyer of th�� d property on date application is filed.
own fidl m� Date (nnndi, day, yea�
appGnnt (num6erantl sveet, cit}; atata,
�ate (monfh. deY Y'��
Atltlress of autharaed person (num6eraM sbeet, ri(y, state, and ZIP coCe)