HomeMy WebLinkAboutMortgage_Davis (19)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C Town ' ar
_ : FOR DEDUCTION FROM ASSESSED VALUATION��^\
State Form 43709 (R11 / 6-W) \1 \
,' t Presrribed M DepartmerR of Lopl GovemmeM Firiance �
� Fil
INSTRUCTIONS:
To 6e lled in F� �� �:
person w by mail wdh the CounryAUditw or Counry Recorder o/ the county where the property is located. ��
Fil'mg Dates: 1J Real Property: Must file durirg the year for which Ne deduclion is sought. quditor
2) Mo6Ae / Manufadured Homes rat assessed as Real PmpeRy Must file dunng the fweNe (12) mon i
6e(ore March 37 o/each yearthe deduction is sanghG �csSO C U TCaYhRqF7EdB�der
See reverse sid�Yo� additional insVUCtbns and qualiflcafrons.
CL�ic7
� ��
Aaessed rdAie o( pmpertY a at Mptqag e/ Cont
Id�G� 1. amM yeat Mard� t, arrenl
<
rc no. wna� ts na � trer eYaa stwe or intere9?
tt nama m 2m�d's dffe2nt than Nat of appOpnt,'v�d'eate Gebw.
(
Nartre of rtnrtgagea or mntrarl sPOi � 1
neeress w �
ormer
sbeet �: �, and LP code)
Oces applitlM Ovm propeily in any ONer
munry in Ind'ana?
❑ Yes
or�u�n aawwea N u,o amoum or.
� �_
Sg�ature N (:mmb nudimr
�
�J
as a �s me epp&an� are sde
legal w cquftade aMneYl
❑ Yes ❑ No
It o+med wiN 5a�ne dhm tl�an spouse. md�le Wih whom
"ra' C uG��� sAm �
_ ���� m���-�u y
�_ ,�D/D -�1�Us-
Is tlx property in questan: Annua�y A55esseE
❑ Real Pinaertv ❑ ?±mua�N Psse�ed
: deOuctim Deen re4urstetl m prapeity
�� ❑ Yes ❑ No
�_ , �
���,�.�Y
i/ We certify wWer the penalry of perjury Nat Ne above aM foregoing intortnalion is We and cortecl and Nat the applipnt is a resident of Indiana and
owner / mntract buyer of the aforemerrtioned property on date application is filed.
�(a�h�re/1yo�� r's rome) � /- Date (month. OsY. Yee�
.W I /_ ��M U \b(nM n�X.
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ezecutetl Power of Attanev or W IC 61.1-72-0.7
Pddress of aWwr've0 person (num6er arM sbeet �: sbte,
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