HomeMy WebLinkAboutMortgage_Dyer"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
,. = FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Form 43709 (R71 / 6-09)
S,�,. r Prestribed by Departmetd o1 Laol GovemmeN flnance
File �� 2 5 2011
INSTRUCTIONS:
To be filed in FO"" �� �'
person or by mai( wiN �he CountyAuditor or Counry Recorder o/ the counry where the property is located. ^
Filirg Dates: 1) Real Property: Mus7 file dunrg fha year for which the deduction is so�ghf. ��COUnry tor
2J Mobde / Manulactured Homes rat auessed as Real Property: Must file dunng the hvelve (12) months
6efore March 31 of each year the deduGion is sought Counry �R rde
IB N COUNT�AU ITO
See �versa side !or additiona/ instructions and qual�catbns.
Appfrant (mmerp� ct buyer- see �rtpqs on revzrse side)
11 l� _n.. `1\ 1) _ . ��L... (I� �n _ _
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If no. what is ha! twl exact share of inte�est?
wrrent
recntl a 6Remn[ tlun that of aVP���. InG'uate Delrnr.
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Amress oi �n oontrad se�er (num0er ana s1ree4 �: slate, eM ZIP ooOe)
Name o� assignee w other owner or hdder ot morigage
MCress of asvgnce (m�mDar and stree; ary, sfate. and ZIP caCe)
Dces appli�ant own poperty in any oNer If yas. wfiat munt�? Wha� Taring C
oouNy in Indiana?
❑ Yes o
COUNTYAUDROR
Deduction appro�ed in Ihe amount ot
20 2f1 20 20
ao��-;���
I I We certify uMer Ne penalry of perjury Nat the above aM toregoing infortnation is true a I
owner I contraa buyer of the aforementioned pioperty on date application is filetl. �17t't
��a wne/shNna
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I� resiEem atltlress o( app6pnt (num6er a sbee4 mY. �te, a�� LP mtla)_
Sr3e� S. �eer�w-✓P�ri .71,r. F'�iirc�i. /N �-7�7b
Pefwn aWm�ad Gy dWy eseated Po+�er o(Aitort�ey or by IC 61.1-12-0.7
Atldress of authaued person (numbe� arM sbeo4 �'. sbte.
Date (month, dzY, l'��l
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