HomeMy WebLinkAboutMortgage_Cross'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear /v
__ FOR DEDUCTION FROM ASSESSED VA4L1UATIOyN
State Fortn 43709 (R11 / 6-09) p,��� T�
,' � Presaibetl q �epartment o( Loral GovemmeN France � L
File Mark
INSTRUCTIONS: q�
�To be fiied in person or 6y mail vAth the CountyAudiror or Counry RecoNer o(�,1� n whe�t�� ro FOfm fl� �:
Fi1� Da[es: 1 Rea1Pm "�� � P PertYislocated.
mg ) perty: Must file dunng fhe year for which the deduc6on is soughL County Auditor
2) Mo6ile /ManufacNred Homes not assessed as Real Pmperty.��i(ue� twelve (72) months
6efom March 31 of each year the deduction is swght. ����� County Recordu
See reverse side /o! addifional instmc�' ns and qualficafions. v A I I I]ITOR
P.ppfrcant(ownerarcontrddbuyer-s _ mrevsrsesqp) n 61BS�BUNT .1
numGer
A�sessetl value oF real propelty as
M2mh 1, dlfPJlt yrdf
ra, �Mat a ttis / tcer exac[ share oi intemSC?
tl �rtie on
Name of rtwrtgagee or contrac( seller
� � ! �� � –O�LXY—UOU . Ul�OE
/ Conbaa iMe6teEr�s unpaiE az ot Mwtgage / Contra
vrtent ye� �� yl �� date of appGotion
Aildress of mongagee w wntract seAer (num6er aM sLee4 ciry, state, ard
w other owner or hdder of mortga7e
Dces appliqnt ovm pfoperty in any other I I( ye5. what
counry in IMvna? ❑ Yes ❑ No
Deduction approved in ihe artaunt of: . _
2�
I I We certify m
ownerlcontrac
�
Recortl numl � I P�elu / / �
as
If ovrtied with someorre other ihan spouse, iMicate wilh wham
COUNTYAUDROR
D �-�„ ��- � o.. o7Df.l ........
Card NO. .......�. �,I�....
aMSLeet �Y, �te, a�j?IPOOtle)
Ptldress of author'ved pe5on (number a�Ashee; dty, sNdte, aM ZIP mde)
zo
Caunry �
Yes L� No
Is Ihe pmperty in QuesSon: Mnually Assessed
❑ Real Property ❑ Armually Assessed
20
Date (monN, day, yea�
on P�openY
20 _
rtnation is true and cortec[ arM that Me applinnt is a resident of Indiana antl
s filed.
Date (month, day, yaa�