HomeMy WebLinkAboutMortgage_Carlile"^n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ a FOR DEDUCTION FROM ASSESSED VALUATION
� Stale Fortn 43709 (R71 / 6O9)
�' ° Preseribed by Department ot Laal Govemment Frence
�VSTRUCTIONS:
!o be filed in person or by mail with the County Auditor or Counry Recorder of the county where the p�operty is located. F q 1
Filirg Dates: i) Real Pmperty: Musf fi/e during the year for which the deduction is soughG ��n Oqudi��
2) Mobile / Manufactwed Homes rat assessed as Real Property: Must h7e dunng the tweHe (72) months C �
before March 31 of each year the deduction is mught. �e�
See reverse side tor additional instructions and aualificafions.
MP�nnt (owner w mnvact buyer - see rcsMrlions on reverse sirlBi .. . _ . . ,. .. . !� �
As�sseC value oFreal P�P�Y as of
Ma�rh 1, anent year
rro, what is his / her exaU share of interesY?
- C>(]U . d " eL C.:
�/ Contrac[ intlebtedness unpaitl as of Mortgage / Contraa in e6teenvs5 unpaiE as
wrrent year date of application
� C�o p0
If owned wiN someone aher than spouse, ind'Kate wm
If name on remrd is SMUent ihan that of appGrani, indirate bebw
jrap�e of mong ee or mn� seller
�i �_.p .
L� T� -
Mtlress of rt Mgagee or contraa seller (number aM sbeet, city; slate, aM ZIP code)
Name of assignee or other owner or holder of rtnrtgage
AAaress of assignee (number and sGee4 �N. �te. aM ZIP code)
v�vem
Deductim appmved in Me amount of:
20
Signature of Counry Autlitw
COUNTYAUDROR
20 � 20 � 20
Counry
legal w� e..p{u�ilade amer!
KI lps ❑ No
�
perty in questim: MnuaDy0.ssessed
Roperty ❑NmuallyPssessed
/ `o .�n•a`.
�ta"�Y jD,..
�a...
c�Ya��� �
� i���.
20 � 20
Date (rtmnN, day, year)
20 _
I/ We certify urWer ihe penaliy of perjury that the above anC (oregoing infortnation is true and mrrect and that Ne applirant is a resident of IrWiana aM
owner / contracl buyer of ihe aforemerrtioned property on date applira0on is filed.
sident 3"ddress of appfrarrt (number a streef, tlly, sfafe, aM ZIP oode)
/30 C ��'JC 5 f�/Lvn,e..�arrc �
�n autlmrrzed Gy tlWy esewtetl Power of Auomey rn by IC G1.1-12-0.7
fddrass of authorrzed person (number aiM stree4 �: sbte, antl LP codeJ
�IJG 70
Date (nroi�N, day, yaah �