HomeMy WebLinkAboutMortgage_Yochum^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
�Y=� .
� FOR DEDUCTION FROM ASSESSED VALUATION
:• State Fortn 43709IR71 / 6-09)
S d Presaibed by DeGe��� 01 Laal Government Frence
�lSTRUCT10N5:
To 6e ned in person w by mail with tlie CountyAudilor or Counry Recorder of fAe county where [Ae property is bcated.
Fdng Dates: 1) Real Property: Must 61e during fhe year fof which tha deductlon is sought.
2) Mobde / Manufactured Homes iw! assessed as Real Property Must file during fhe fwelve (72) months i�
6efore Maich 31 0( each year the deduction is sought.
See 2verse side loraddrWnal insVUCUons arM qval"fiiratrons. C
e....F,nn�l.wmnrrv buver-5eem.sf+itSipncmreversP.iidel /1 . � /
��
no, what fs h¢ I her e�ct share of interest?
�m¢ pi r¢cord is EitFerent ihan Nat o( aPpl
Name of rtart8a9ee ar
:�T'1
'�
Mortga9e / Contract i
Martli 1. art�vj ye3
Year
1 ��r{'.ayntyAuditor
�CounTy Recorder
COUNTY
1 as of Mor�qage I Cantrarl uMebtednrss impaid as d Is ihe apprmant ihe sole
dete o( eppG�ation �egal w epuitade avmel.�
❑ Yes ❑ No
If wmed wiM samea�re a�her ihan spouse, I�'cate with whan
Is ihe property in question: NinuaDy Ps.ussed
❑ Real RoPertY ❑ F!^^�!�Y �� . . -
aCt SeOe( (nulnbPf ard 5t2eC��Y 5t3fC. ari0 LY c00d)
nerahoWUofmortga9e . '
aMSnee4ctiY.sG . �_- ^WW � � �`iV�`+��' • •
r
�
Does e�limnt own property in
munry in Ind'ma? ❑
D a��ei \0 ...............
,�,� a���-385a�
❑ i
CardNO . .....................
��,�m�a��of
P
Has Na dedurlion Eeen re9uesteE m property
For arrern yeaR ❑ Yes ❑
�_ p_ zo_ zo_ zo_ zo_ zo_
aaWre U Co�mN AuEitor Counry Da�e (rtanth. daY. Yea�
I/ We ceNfy under Ne penalry of perjury that the above and toregoing informalion is we and mrtect arM that the applinnt is a 2sident of IMiana ard
owner I conVact buyer of the aforementioned property on date apDlication is filed.
�naWre (o�mers me) Date (monfi. daY• YgaA
�I resiEent atldress d appGpnl (num6er antl srvret dty, state, a e)/�_ �'� /// � / i��� z Q
/d8�0 LU ni �-� clu�/
authorrzeO by dWy ezecueed Power o(AituneY a M IC 6t.1-72-0.7 �� (^°^�h. �Y 1'�a�
Idress of a� person (numbe� aM sbee4 �Y. sbte, an0 ZIP mde) .