HomeMy WebLinkAboutMortgage_Brown (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
:,_,_ _ FOR DEDUCTION FROM ASSESSED VALUATION �
� Stata Fortn 43709 (R71 / fi-09)
�' ,,,. � Presaibetl �y DeD��M of Loml Govemment Frence
Fie a
�vsrRUCnoNS: MAR 6=rt^ � 69n
k 6e filed in person w 6y mati wifh the County Audita or Counry Recorder of Ne counry where the property is located. � iC �
Fdirg Dates: 7) Real PropeRy: Must file during Ne year (or which Na deduclion is sought Q County Auditor
2J Mobile / Manufactured Homes rrot assessed as Real Property: Must file dunng the fweHe (12J month� ��. �
before March 31 07 each year the deduction is s�ught Gounty Remrdu
v
See reverse side for additional instructions and q�l�wtions. G I BS ON COU NTY AU D�Tr1R
IAGd�n�owreror mnLaa buyer - see reslnUibrts o�ir�verse siie)
[�ISJnG Key rcanDEr / I¢g21 aCSCipUpn Remrt1 nUmh¢r Page numbrf
�_o-�a�� o�(�- d-a�-zo/-ov3.Syb-D�7 �v�d- �89
zd va4ie d real propeny as d tdmtgage / Cantraa inde6teErress unpaiE az W Mongage / ConvaU uWebtedness �mpaE as o( Is ihe aD�+t Me xle
1, ament year Martl� 7, aurent yeer Cate o/ aDP��� n �egal w equitade oxnM
� d%, (� O � ❑ Yes ❑ No
his! her exaG share of interesi?
on recwd
,^,,.. �
Name oi rtqrt�agee p wniraa Seller ��
Address of nnrcgagce or cantract seller (numbcv and svaef, ciry,
Name o( assignee or aher owner or halder of mortgage
Dces applimnt wm
munty in Intliana?
M stree4 -. slafe, and ZIP catle)
any oNer If yes, wha
Yes ❑ No
DeEUCUm apprwed in the artaunt of:
zo � zo � zo
sgnan�re
�f owntd
and ZIP code)
[K�DL`Y�7cRJ�7i[�77
za _
Caunry
Is Ne property in Question: Mnually Assessed
❑ Rea� amvenv ❑ /���N �
Moale Hartie (IC 61.
DNri -'.-'._.._.•_•..�.—•^^^•wucrodonn�WeftY.
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c��-� ,�o. ...ag%
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Z`� �8'1� OG10. °�. �. N. �,
I I We certify urWer the penalry of pe�dry that the a v and foregoing infortnalion is W e and corted and ihat the appliran[ is a resident of I�iana arW
owner / contraG Wiyer of the afwementioned prop rn date application is filed.
� SgnaNre (owneYS MI name) Data (npntli. day, yean
Full 2sidenl address o/( applicant (num0erand sLee( ciry, state, and Z!P ootle)
Z% L le NlA/VU br�V-e �f�NCf�ON �(� y%�j7()
Person auUro'rzeE Ev GWv executeG Power of Attomev or W IC G7.1-12-0.7 Date lmonlh. dav. ueall
person (numberaM saeet �ry. state. and LP mtle)