HomeMy WebLinkAboutMortgage_Clem^�� STATEMENT OF MORTGAGE OR CONTRACT E�N� Coun 7ownship vear
_ FOR DEDUCTION FROM ASSESSED VALUA �
Stata Form 43709 (R71 / 6-09) '
S � t f wcal Gove t F nce
� Pr¢srnbed by �epartrren o mmen ua
APR 1 9 2012
�srRUCnoNS:
To 6e filed in person w by mail with the CounryAUditor or County Recorder of the co��ity.wh@i�Y� is located.
Filirg Dates: 1) Real Pmperry: Must file during the year /w which the deducfion is soughf.
2) MobRe / Manulactured Hortres rwt assessed as Real Property� Must file dunng the e 72) monfhs
6efore March 37 o(each yearthe deduclion is sought. ��BSON COUNTY qUDITOR
See Ieverse side 7or ad¢eiqnal instruUions and quali�cafions.
,e d m� a�avem � m
a4 year
his / Mr e�oct share of intrlest?
11 �artre m remrtl a SAferent Nan
Name of mart9agee or mntrad
r / legal desaiption
�(�- �a-oq-loo
MMgag� /Contraa4debtetlness
MaR3� 7, a,rtem y� / _
belrnr
moMgagce w contraa se0er (numbu aM sheeL cilY. state.
other owner or hdder of morigage
o( as99nce (num6er aM street my. sbfe,
Does a�i2nt own ptoperty in any ol
coumy m Ird�ena? ❑ Yes
I
Oduction approved rt� ihe amount of:
2�
File Mark
Fmn f�ed wiN:
�CountyAudimr
County Recorder
�a.s i�-aa� o �-�- i5'��
as d Mortgage / ContraG "u�debiedness impaid as ot Is Ne apPlMant Me sole
tlate of appfifation � w epuibde ownrY?
❑ Yes ❑ No
I H Yes. what munyl I V
No
GOUNTVA
�_ i Zo_ i za
spouse. iMifate wiM whom
Is Me Property in QuesUOn: MnuaDy 0.ssessed
] Real RoPeKY 0 ��N �
MoNle F�brt�e (IC 61.
_- ' ___ _„'„urs on prtqelty
Dra�ti�er NO....��( �-
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Card NO. .....�� j��
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I/ We ceNfy under Ihe penalty of perjury i the above and fo oing infortnation is We anC cortecl and Ihat Ihe applirant is a resident of IfMiana and
owner I contrad buyer of ihe afaemen � ed properry on date application is 51ed.
Sig�aWre (owne/s futl nartre) Date (monfi. GaY• Yma�)
F residentatldresso(appGCant(numberandsLee(riry,s7ate,ardLPmtle)
� a �i� r
Person authoraeE M dWy ezecuted Parer of AttomeY or by IC Gi.1-72-0.7 _ Date (monfh, dzy. lea�
AEdress ot auNa'ved per'..an (n�m6erarM stree4 �+h. ��, and ZIP