HomeMy WebLinkAboutMortgage_Carey_^'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Couni
� FOR DEDUCTION FROM ASSESSED VALUATION
• Siace Fartn 43709 (R17 / 6-09)
S � Ptewibetl by DeparVrieN of L�1 Govemmenl Frence
w.
INSTRUCTIONS:
To be filed in person w by mail with the CounryAUditor or Counry Recorder o/ Ne counry where the property is located.
Fi!'mg Dates: 1) Real Pmperty: Musf file dunng the year fo� which the deduction is sought.
2) Mo6de / ManuFactu2d Nomes not auessed as Real Pmperty.� Must fi/e dunng tha hveNe (12) months
befae MarcA 31 0/ each year the deducfion is sought.
See Ieverse side f� additional insfruclinns and qualifications.
MM��t (owner conhad euyer- sea resfirlw�n re�sitle)
F�, ���,�: 2
- -a- u= uo. da-uo� U-��i ,,
As�eC �ahie d real piaperty as of Mortpag e/ Contraa inde6tednass unpaid a of Mortgage I Conrap'videbtedness unpaiO az d b the epp�cant Ne sote
March 1. anmt year Marr3� 1. artent year Eate of aPP��� / kgal w epuRab�e o.meR
/ �(p � ❑ Yes ❑ No
If ro, what k h'a I her esaU share of intemsl? If vamed wiN sameorre dher ihan spouse, ifMicate wtth whom
It name an record a dMerent Nan that af apP�4 mdidte bebw. Is property in Questim: MnueM Assessed
� �Real PfoveM Q ?nmiaMwssessed . - '
Name W rtiortgagee or
w mntraa sWer (number
assignee w oihu awner or hdder ot morigage
cdy. stAte. eM ZIP code)
(number aM svee4 �; sfete, aM LP tode)
Oces e�imnt own p�operty in any oNer
counry m Irid'aru?
❑ Yes
Or�uctlon approved in Ure artmunt oE
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COUNTYAUDROR
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Counry
I/ We cerOfy urWer the penalry of perjury that Ne above and foregoing informalion is We and cortect
owner / contract buyer of the aforementioned property on date appliption is filed.
( Sigrianue (ovmers hID rertre) .
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Futl resitlent address ot appGrant (numDer an sLeef, dty, state, ard ZIP ootle)
� .S3 9-So ... t�, �o .-r t � L c. n c
� Pason autMmeE Ey Mtly ezewted Power of Attomey w IC G7.1-12-0.7
person (num0er arntl street, cify, stafe, and ZIP cade)
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Ha5 N6 tleGUdion Eeen reQuestM at n�.�—' �
ror �„rtem yr,an _ _ --r �
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Cara �O' .0�� . p� .
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the appliranl is a resident of Indiana arM
3te (monfi, day, yee�
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