HomeMy WebLinkAboutMortgage_Holley� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ + FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 43709 (R71 / 6-09)
, w. � P�esaiDetl M��rrt of Local Go�.emmerd Frwce
INSTRUCTIONS:
To 6e fited in person a by mail wdh the CountyAuditor or Counry Recorder o/ Ne counry where the pmperty is bcate�
Frling Dates: 1 J Real Property: Must file durrrg the year /or which tha deduclion is soughL
2) Mobde / Manufactured Homes rrot assessed as Real Property Musf file dunng tAe twelve (72) months
6efore Ma�ch 31 0( each year the deduction is saght.
See reverse side !or additbnel inshuctions and qualiflcations.
Ap nt ownei w mntraC b r- see prestiir'.tions my yrev�erse side)�� �� �% .
n...–�.[� �OQ /l ¢// 1 O/I.Ue U.Gl X—K�Y OOU
��a _ Key iwmDer / legal dnsrnptrn
# real poperty as
Y�
n ro. wnat ts na � Icer exa� snare o� mterest?
If rwne an iemd ia 6Rernn[ tlun Nat af app6mnt, Mdkate bebw:
Name of rtnrtgagea or mnvarl se�er / S-j
Mdress of rtnrt9agce ar cantraa seuer (n�m6r� and
rt�ortgage
�
stale. and
t :
— LU
Counry Audiior
Counry Recorder
i as d Mortgaga / Con� irde6tednesx unpaW as d Is Me aPP��t the sok
data of eppOCatm legal or equibde arnM
❑ Yes ❑ No
N ownetl wiN somearre dher than spouse. iridinte with whwn
Is tlie PbDertY in quesrim: Mn�aM Aa5es5eE
ealaroaertv Q?nnua�Nw�...
Oces eppfuant wm properry in any aher I If yes, what munt�R I What 1
counry in IMiana? ❑ Y2s ❑ No
DeduGlion epprweE in Ure emount
�y�STDPI-��� �'
N�� m �s�� .�
av���gq � � No
20 _ 20 _ 2q _ 20 _ 20 20 _ 20 _
$ig�Nre of CamtY Autlkw Counry Date (�^�. daY.1��
I/ We certHy under the penally of perjury that Ne above arW faregoing infwmalion is We and cortec[ arW Mat the applicant is a resident o( I�iana and
owner I mntraG buyer oi ihe aforementioned property on date application is filed.
SlanaNre GW�erS hID name) i Date (monfi. daY. Y�)
x �- Y�- f6�-�-
F�ID rnsident eENass of appGmnt (number and sbee4 �1: �te, and LP m
x am o s i sro i— �'
Pr�sm author¢ed Dy dWy exewted Power o(Attm�ey or by IC 61.1-72-0.1
Pddrass ot autha'ved pn�sm (number a�N SbEe; dy. sfata, and ZIP cotle)