HomeMy WebLinkAboutMortgage_Sollman (7)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cp Tow p Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
Stale Form 43709 (R11 / 649)
� f P�esaibeE by DePM�M al Loral Govemment Firence
INSTRUCT70NS:
To be filed in person a by mail wifh the CountyAUditw or Counry Recorder o� Ne counry where the property is bcated. C' '
Filing Dates: 1) Real Pmperty Musl fJe durirg Ne year for which fhe deduclion is sough(. Auditnr
2) Mo6de / ManuFactured Homes rat assessed as Real Property: Must fiie dunng the fweNe (12) mva�ON O N Y er
6efore March 31 ot eacA year Ne deduclion is srought �°fd
See reverse side !or additional insVUCtions and qualifications.
Aodican1lowneroroonvaCbuyer-seeresMC(mosmreve�e,yde) 1
Tap o� � -' Key �n« i rese� ae�poor� Record numEer Page num0er
a /o -L _ p - Z�G � � Oa � 0�0/
vahie �f rea1 WoP�Y az of l�AOrtgage / CanVarY indehtedfress unPaid as d Mortgage / Cmtrarl udebtedness unpaid as oi h Ne sPG�+� tlu sde
1. amHR year mh 7. w�RM Cate of ap�fifation kgal or equrtade owrnl?
�70d ❑ Yes ❑ No
tt no, what 6 his l titt P.rad share of intrJesl? If owned xdN samewre aNer Ihan 5pou5e. iMicate wifh whwn
It name m mmrG ¢ Ailfuent ihan thal of aPP�^�• �icate bebw ,. Is tl�e ryoperty in 9ue5UOn: Mnuelly Assested
�tea� a�nv ❑ rw,!,aMa�ed
Name a rtnneagee
Address o� rtprtgagee
ciry, 5ate, aM ZIP code)
pA USD � 5o L � rn c�►�
owner or hdder of morigage
aM shee4 �y: s+a1e, and LP code)
Dces applimnl own prOputy in any oiher
counry in IMana?
❑ Yes
Dr�uction appwec "u� 1he amouN of.
20 20
Ityes,xTatmunt�? IWhall
COUNTYAUDROR
20 20 20
ao�� - a3��
20
�Y. Y��)
20
�toputy
I/ We certify uMer the penalry of perjury Nat �he above aM foregoing infortnaGon is true and corteU arM Nat the applipnt is a resident of Indiana aM
owner / mntract buyer of Ne aforementbned properry an date application is fileC.
IC.�o.....� i c%jo��..
Full resiEerrt aAdre� N appi'rant (num6erarM stmef, tlry, state, arM ZIP cotle)
//I 3 7 S� sa E Ha�6 �/f�.iN v ��
Person aufho�'¢EE Gy EWy executetl Power W Ativney w by IC 67.1-12�.7
Pddress of aulha¢ed Dere.on (number aM sbeet, dry, sbte. and ZlPCade)
oa�e c,�oMn. ea,:
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