HomeMy WebLinkAboutMortgage_Anthony^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year y
:y'_ .
FOR DEDUCTION FROM ASSESSED VALUATION
:• State Fo�m 43709 (R71 / 609)
�' Presaibed by �eV��nt of Local CavemmeM Fnance
� � File Mark
INSTRUCTIONS: '
To 6e filed in person w by mail wilA the CountyAuditor or Counfy Recorder of Ne county where the properry is locafed. �
Filirg Dates: i) Real PmpeRy: Mus! file tlun�g Ne year for whirh the deducfion is sought. �� d'Rnr
2J Mobde / Manufactured Homes rrot assessed as Real Property: Mus! file dunng fhe hvelve (12) months
before Ma�ch 31 0/ eacA year the deduction is sought. ❑ �yn ecorder
See reverse side foradditbnal inswcGOns arM qualifirations_ GIBS
Andipnl (owneror canfrM byqy�e resMCtiyr�s m ravr�e sid� � A A
yn ypar .
his / hu exar� share of infsest?
' - ^ f> - I 1 � dJ
�Ba9e / Contraa uNebtedness unVaiO as W• Mort9a9e / Cmvarf iMeWeMnss imVaid as d Is fie aPP�t N wk
Ma�tli date of appGCation iegal w equita6le awTwlt
O ❑ Yes ❑ No
If ow�red wiN someo�re otlrer Nan spouse. uMicate with whom
u
If name m remfG is dfRemnt Uan Nat o( app6ran4 uMifate 6ebw.
Name o( mortgagee or mnb2cl seller
lddress of mortga9ee w cmtraG u0er (num8u ei
Name ot azsi�ee w a7�er owner or halder of mom
MEress of assi9rree (number aM sLxe4 �}: s+ate,
Ooes e�kant bwn property in anY oNer
countymindar�a? ❑ Ye5 ❑ No
Detluction appoved in Ne amount of:
20 20 _
Signahrte ot Cwmb AWitnr
andLPCOtle)
lll':l\1'�C ��..�0�!.�.......
c��-a �o. ..... � 3 I,�.....00
_ ��I,iSo. -
20 � 20 _ � 20
I/ We certify urWer Ne penalry of perjury that Me �
owner / mntracl buyer of the aforementioned pro
� M i5�f13
' ent address of appl�nt (number antl stree(, ', s�
Z3z � ' L
auUar¢etl Dy d�dy ezecuted Power W Attorney m by
Coimry
h Ihe 7�7ertY in Vurstion: MnuaDy Assessed
❑ Real Roperly ❑ Nmually 0.ssessed
hbhle Hane (IC 67.
Mas Nis deEUtlion Deen re9ursled on pmperty
for tvr2nt yeaR � Ye5 ❑
20 � 20
yea�
nC foregdng infortnalion is We and cortect and that the applicant is a resident of I�iana aM
date appli tion is filed.
Date (morvh. day, yv �
_ . �_, 1.�1
� i0 ' �'
Pddress of autliu'ved persm (number arM sbeet ciry. sfare, aM LP tode) .