HomeMy WebLinkAboutMortgage_Clark (7)"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ • FOR DEDUCTION FROM ASSESSED VALUATION
Sfata Fortn 43709 (R71 / 6-09)
� PresaibM q' Department ot LoW Govemment Finance �
File Mark
INSTRUCTIONS: MAK A .
To 6e filed in person w by mad wiN the CountyAuditor or Counry Recorder o( the oounry wAere the pioperty is locatea �
Filhg Dates: 7) Real Property Must file dunng the yrear 1or which the deduction is soughL � Counry Auditor
2) Mobile / Manufactured Homes not essessed as Real Property Must file dunng Ne Iwelve (12J monMs-�, y��
before March 37 0/ eacA year Ne ded�ction rs sought. ��1,: rtil -. ^�Y Re��
� �
SeerevarsesideloredditiWnafinstructionsandqualifications. SON COUNTY AUDITOfl
Appfecam (owrer w convarl6uyer -;pe restri�b'ons o ia/ q wm side) . � j'� �_, n
y°� i// n i r� J % Y
L_ C��r v Ki— �(��%
Ta '� Oistrirl Key twmbel / legal desaipCv� Recortf number Page numba
� a�-r�-� -a-oa_oo�. 9 ao. oa7 00 � 8
Atsessed rah�e d real pmperty as d ge/ Contraa'udehtedness unpaid as d Mangage / Con�aR trWebteAness unpaiA a d Is Ne app�rcem the mle
Me�rl� 1, am�nt year 1, anent Eate M appGratnn legal w equilatle oMneR
(� ❑ Yes ❑ No
11 no. wha� is ha! her exaG share of inturst? If ovmad wiN someone oiher than spouse. udimte Wih whnn
�M name m iemrd is CAlerenl than ihai W aDP��4 irMinm Gebw. Is ihe in Vuestion: MnuaM Assessed
Property ❑FVInuallyASSSe555ed
AbWleHOme IC61.1-�
Name of rtnrtgagee ar rmtrati se8v ��
AAdress of rtnrtga9ee «mntrad se0er (nwnbrs sLaeL �y. smte. aM ZIP tode) _—
Nama of assi�ee w othc wmer w halEer of rtpr�qage •
AdEress of as9gnee (num0er eM streeG �: stefi, arM ZIP code) ._._ ___
Does epplicant rnm property in any oNer If yrs, whet muntyl Wtat Tebrg Distn 2 //�
counryinlMiana? ❑ Yes ❑ No r/ �L 1
DI'II11'Ct' \Q ...................
COUNTY AUDROR _ � �� „_
Ordumon approvad 4� Ihe amount ol: �� �
Card NO. ...... ...�:�.......
zo �_ �_ Zo_ � ��13��i�.��
SigfaMe d Camb Audimr /L � Caunry Date (rta�. dsY. Y��
/�J
I! We certify under N nalty of pe�ury Mat e above and foregoing informalion is W e end mrtect a� Nat the applirant is a resident of Intliana aM
owner! mntraq buyer of Ne afoiemention pmperry on date applicalion is filed.
\, Sq�ueue (owna/s !u� narrre) Data (rmrtA. dar. Y��
�(
� FupresiAe (numDere L �.sfe , rZfPoode) _(
i� C� 5
Pe�..on auNorized Gy dWy ezecuted Pov.et of Attaney or Cy IC 67.7-12-0.7 �ate (rtpnih, tlay. yea�
�AACress of aWior'ved persan (num0er eM sbeef, dry, sfafe, en0 LP mde) .