HomeMy WebLinkAboutMortgage_Bryce"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun hip
_. FOR DEDUCTION FROM ASSESSED VALUATION
� Stata Fortn 43709 (R71 / 6-09)
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wsrRUCnoNS:
Form Ned with:
To 6e filed in person or by mail wiN the CounryAUditor or Counry Recorder o/ the counry where the properry is kcated.
FrNrg Dafes: 1) Real Property: Must 91e durirg the year for which Ne deduclion is mught. � u� d' r
2) Mobde / Manufadured Homes not assessed as Real Pmperty: Must h7e dunng the hveHe (12J rtanMs I�I (y
6efae March 37 oieach year Ne deducfion is swqhG �I. 39�i-[36 y A dj�,�gp
Sea reverse side hu addifional instructkns and quelfications.
� or mNrad buY9rT %� ��S��T �^/sYe� �) i n
Asu� vdNe d mal P�P�Y a d
M1te�� i. a+ren� Year
It ro, whal ts his / icer exad share of u
' name m �eooN is dRfumt than Na
Name of rtarigagee or mntrad seller�
naaress d rmrtgagee s ca,aaa se0
Name of assiunee w ather ovmer rn t
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Me�h1e/Con � e
wrtenl
cani hlCi�ate EebW:
ier e sbee4 '. smm. artl
�a9e
ACCress of assi�ee (numoe� end saeeL cuN, s+e+e.
ction appiovaE in Cre artnunt af.
20 _ 20
R¢mrtl numbrj Pape n mCel
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s unpaitl as d Mangage / ConraU 4idebiedness un0aitl as d Ls Ne eAP��t tlre sde
Cate of aPP��� /7� � �I O de O
�� Yes No
I If yes. what wunty?
No
COU
20 20
someone othar Ihan spouse.'udirate Wih wMm
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DaLL (month. CeY.
1/ We certi(y urder Ne penalry of perjury that �he above and foregoing infortnation is true and cortecl aM that the applinnt is a resident of IrWiana aM
owner f d buyer of the afaementioned property on date application is filed.
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Pasan auW�E Gy
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or W IC 61A42-0]
pason (number arM sLee4 �: sbR, end ZIP ootle)
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