HomeMy WebLinkAboutMortgage_Dilbeck^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun o nship Y
__ - FOR DEDUCTION FROM ASSESSED VALUATION
1 �• State Fortn 43709 (R11 / 609)
S 1 Presaibad by DePartmenl of Local Govemmerd Firence q ,p�,�
IYI��`D"Y 20��
INSTRUCTIONS:
F
To be lled in person w by mail with the CountyAuditof o� Counry Rernrtier of fhe counry wheie the property is located. �. .
Filirg Dates: 7) Real Pmperty: Must file dunrg the year fir which the deductan is sought. � Cou A or
2J Mo6ile / Manufactured Homes rrot assessed as Real Property Must file dunng the fwefve (72) monfhs �1
6e(o�e March 37 of each year the deduction is soughG G I SOI9-ii O1A99^1Yf•iSW'�&R
See reverse side lor additionel instruct'�n. and quali�cation� /
�An�n lai�ierula2intractbuVer-sBe mreverse el .
I ' � /�I!S. / /LI � /_ J � / L•i/!�
i.. _
1f fame on recorC is dAterent Nan that of appGant. h�dirate bebw.
M mmgagee w mntract seuel(
assi�ee w oN�er owner w hald
of assignee (number arM stree4
plifant ovm properry in any aNer
i Indiana? ❑ Yes
m Remrd number
'-ODd ��% 40��
aa inde6tedness unpaiO as W Mwtgage I ContrarY udeMedness unpaid a of
year date of appaatim� � ��/ �
num6er and streeG crty. sfa�. aM ZfP code)
er W rtqrtgage �n
�J
cdy, sfate, and ZIP cotle
If yas. whet muni)/.�
tt awnad wiN someo� other Ihan spouse.
Page numb�i
u equilade amK)
❑ Yes ❑ No
�I-syt5qe propeny in QuesGOn: MnuaP/ Assessed
CJ Real PfoPeKY ❑ %�nn�a�Y AsSe�
Sted a� propPriy
Yes ❑ No
- — 9NTYAUDROR \ /
Detlucaona7G��m��r-'- - /;E�3'
/�
zo _�SL+3��K� ��M�'1 �� A � zo _ zo zo _
�a �IN�'� j�SoURC�
sg�,aw�e o A l'n �/� � ca,�ry oace P�,n,,. e�r r�d
E����ll� �a_�yl�
I I We ce � ._....+e and foregoing infortnalion is We and mrtect arM Nat the applirant is a resident of Indiana aM
owner I c __..... ementioned property on date application is fiied.
� ��
� F �
PersOn
author'ved pe�srn (number aM shee; dry. state, an0 Z/P code)
Date
yea�