HomeMy WebLinkAboutMortgage_Deffendall""+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ , FOR DEDUCTION FROM ASSESSED VALUATION
State Fartn 43709 (R71 / 6-09)
� r«. Presaibed M DePartmeM af Loral Govemmerd Finance �
INSTRUCTIONS:
b be filed in persan or by mail with the Counry Audifor or Counry Recorder of Ne county where the poperty is located.
Fiti/g Dates: 7) Real Proparty Must file durirg the year (or which Ne deduction is soughG
2J Mo6de / MenuFaUured Fbmes rrot assessed as Real Prtiperty: Mus[ file dunng the fweNe (72J months
befora Maich 37 0! each year Ne deduction is sought.
See reverse side for addRiona/ insLUCtions and quali�cations. _
ettl� i. Gr�Pf¢ yrlr
�ro, whal h his / her erad share
r�afrie m remtl
Counry Recorder
_'�, nany� � I}ga� �G —� �' l` l � I�1..10 I." a 6�-o a RemN V P�e �K7
v ��
of Mortpage,LBQpCaG "u�tlebted �s unpaid as W MMgage I ConTaa mdebtedness unpaiA as of Is Ne epp8rarit the sde
MeRh 1 M�rf --7 O� tlate W app6catm legal a equilade owneR
� ❑ Yes ❑ No
of infemst? If owned with someone oNer Ihan spousa, i�Micata with wMm
mntrad se0er
morlgagce or conva�Y se0er (nunEe� aM stree4 u(y. dtefe. arW LP cade)
Name o1 assignee w oNer ovmer rn halder of rtqr4laGe _—
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_ — I p— 20—
IW�at Tavnj Oistrirll
couNn nuorrort
zo_ 20_
Is ihe p'operty in Qurstim: MnuaOy Assessed
❑ Real ProPeKY ❑ M�w�IY A�s�
#loble Flome fIC 61.
Has Mis deGUflion Ecen reGUesteE m pmprlty
fw turmnt Y�r' r� _. r�
� I �
�w�s +ra�an°f Y� I ca�ry oa�e t °ay �n ��
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I I We ce�fy urWer e penalry oi pe ry that Ne above and foregoing infortnation is true and cortect and that Ne applirant is a resident of I�iana aM
owner I mntract bu r of the aforementioned property on date application is filed.
bY �Y
(numDer anE streeG dry, sfale, aod LP oode)
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(num0er aid s�ee4 �: sfa(e. an0 ZIP ootle)
Date (month. daY. Y��