HomeMy WebLinkAboutMortgage_Davis (15)p� STATEMENT OF MORTGAGE OR CONTRACT INDEBTE[
�_-
- FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 43709 (R71 / 6-09)
� � PreuriEeC by DePaM�M Of Loral GovemmerLL Frence
�STRUCTIONS:
6e filed in per5on w 6y mail wifh the CountyAUd'rtor o� Counry Reoorde� o! Ne counry ti ere
Fi7irg Dates: 1J Real PmpeRy: Must file dunng the year/or which tha tleducfion is soughf.
2) Mo6i7e / Manufactured Homes not assessed as Real Property Must !Je dunng
before March 31 of each year Ne dedu�lion is sntght.
See 2verse side 7of adtlitbnal instructions a� qualifications.
T Tg i 'a Keyrwpiber/IE
o< <s�
assess�a �aa,e �r � �cy as w r.�
MaN� 1, tlmnt yrdr Ma�
II no. what is h's / trer exarA share o( interest?
11 name on remtA ig tliR¢r¢nt Nan that o( apP��t. in�
Name of mongagee or crno-act se�er
mort9a9ee or
aaare
iNESS Coun Township Year
�P�� File Mark
Fortn fileO with:
�Counry Auditnr
DE�e�eg12[���5 ❑ CountyRecorder
�� tivy. ia3�a��..,...., a��'ic P�s���
/ Contract inde6tetlness unpaid as U Mortgsge / Contrad indebtedness unpaid as d Is the appGrant tlre sde
v�,��5Ob0 ��o���, '�� oY� a
If owned wrth mmeorie other Cun spouse. indirate with wfqm
xbvr Is Me D�Oert1' in pue5tion: Mnua�Y Ass¢sed
❑ Res� a.oPeny ❑ nnm,a�y asse��
(num6er aM sveef. ctiy. sfefe. arM Z/P code)
Oces al U O / � . . . . . ..
W„�h, Dra�r�cr \0.........
.... � .............
( Card NO/�• s ��
Deducu< // J/ ��,(,U
OUNTYAUOROR
20 � 20 _ � 20 � • 20 _
I I we certify under ihe penalry o( perjury th�j the above and f<
owner I contract buyer of ihe aforemerrtioned property on date
' ��`�c��' �. � :s
Full ent aEtlrnss o/ appGrant (num6er aM street+_-tl�yry.J. state, a^nd LP
� � � ��� \ �\\\C
Person auUqi'sed by Euty ezewted Power of AROmeY � M IC 61.1-12-
Atldress of authoi¢ed person (number antl Sbeet dry. sfafe, arrd ZIP code)
Caunry
Iror a,rrem v�n.
20 20
Date (rtpp(
����� � �
20
I I � (T�-1 � 1 J
irtnation is We and cortecl arM that Ne applican[ is a resitlent of Indiana aM
� fil�.
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