HomeMy WebLinkAboutMortgage_Sisson"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
• Slate Fomt 93709 (R71 / 6-09)
� � Presaibed q' �eGartmant of Local Govemmeru Finance �
�u.
INSTRUCTIONS:
To be filed in person or by mail with fhe CountyAuditor or Counry Recorder o/ the county where the property is lorated. A P
Fi!'mg Dates: 1J Real Prope/ty: Must file dumg Ihe year for which Ne deductnon is soughG
2) Mo6ile / Manulactured Homes irot assessed as Real Properry: Must fi7e dunng the twelve (12) months
befora Ma�ch 37 0( each year the deducfiar is sought. `--y�
See 2verse side for additional inshuctbns and qua/i�cafions. �,r
,�,�` e,�in�1a."�`- �`°�1°`��u.�i�a-�°p S�.ao1!�r�
_
P/s{sed vaNe d real Pm�tY as
iI�hh 1. pim¢ year
tt no� wfiat is ha / tcer exaG sl�art
I1 name at 2mttl is dAferrnt tha�
hditatE DeMw!
-000• �ab-ba�c
Name of rtnrtBa9� a mntrar� se4er
51 3
ACdrea o1 mortga9� or mntract se�er (nwMar aM sLeet �: ste�. end LP code)
Name M assignre w other ovmer rn Malder of mM6+ ��Q�1'� A S / —
L
Addfas5 of assi9�ee (numbereMsneeG mY• 5taffi. �� � l(-TS �
Oces applimm ovm pmperty in eny oNer "�� �
counrymlrWena? ❑ Ye5 ❑ No
doio- ,CS��
amount oY.
Remrder
btedness unDaid as of b t�e aVP�t tlro sde
� legal or eQUttade awneR
❑ Yes ❑ No
spouse. 4Mkate wtth whom
Is ihe yopercy in Question: MnuaOy hssesuE
� Rr21 PfoPenY Q Mnua1�1! A��sed .._
m ptopeity
❑ No
2p _ 20 _ 2q _ 20 20 _ 20 _ 20 _
irenae d Counb AWrtor Counry Date (month. daY. Y��
I/ We certify urder Ne penatty of perjury thal Ne above and (oregoing infartnalion is We and cortect arW Nat the applinnt is a resident of IMiana and
owner! contra�i buyer of the aforementioned property on date appiication is filed.
Pason auttni'v.ed M dWY ezearted
Pddr� af autlwrrse0 puson (n�m
ary, state. and LP oode)
sfa�e. antl LP cnde)
. _ I Date (m�