HomeMy WebLinkAboutMortgage_Ingram^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C T hi Year
__ , 4 FOR DEDUCTION FROM ASSESSED VALUATION
. . • Stata Fortn 43709 (R71 / 6-09)
�' y,� � Prew�Detl by DeVartmeM o( Loral Gm4mment Frt13nce
File Mark
INSTRUCT(ONS: �U � �
To 6e filed in person a by maii witA Ne CountyAWkor w Counry RecoNer o/ the county whe2 the property is bcated.
Filirg Dates: 7) Real Pmperty: Must �le dunig the year for which the deduction is soughL C. , h� ���Z -"°'V' Auditor
2) Mo6i/e / Manulactured Homes /rot assessed as Real Property Must file dunng the tweNe (72J monfhs
before Mamh 31 of each year fhe deduction is mughG Recorder
See reverse side lor adtlitional instructions and qualifications. G I BSON
MP�W(owneroroonvartpuye:.-see?svirll°7s9"reve+seside) \ 0 � �
7'� 'strid � Key numDer I Iegal descriptiqm q '7 Recofd numEer Page number
�� -✓�Q QQ�.V� -Q� / � �
Assessed rdlue d real P��Y as W Abrtgage / ContraC iMeCtedrress unpaid a af Morigage / Con�ad'ude6te0�ress un7� as d Is tlie aOP�t Ihe sak
INarth 1, pment ymr March 7. wrterit year Eate of appGcatm 1e9a1 w equitahle owre(1
� �� ❑ Yes ❑ No
1( ro. what is his / her e� share of inturst? If wrt�ed with someone dher Man spouse. iMkate with Mam
tt�rtie m remrd s dAfuent Ihan Nat of appGcant, Ind'uate Debw. Is tl�e propeny in Question: Mnualy AssesseE
eal RoPertY ❑ Mnual�Y Psse�
n�oak rwme nc �i.i-,
Name of mongagea or conttact
neeress m mortgaqee «cmaaa
w o�er wmer a halder M mortgage
ALUress ol assgnee (numoer arra suee; cuy. srate, ana ur coae7
Oces epplinnt wm property in any other If yes, what
counryinlndiana? r'l „__ I-1 .�_
Deduction approved'oi tlie amoun
20 20
Sigreture ot Counb AuEitor
aM LP oode)
COUNTYAI
17UGRAm, �oua{�j � ,�
]��//1 /�,� i m P�W�Y
' In�CI./-1' �-- s ❑ I
01���'- ��1��
20 � 20 _ � 20
Counry
20
I I We certify ufWer �he penalty of perjury that Ihe above arW (oregang infwmation is We and cortect aM Nat Ne applipnt is a resident of IMiana and
owner / mnVact buyer ot Ihe aforemenibned properry on date application is fitetl.
��nye (a»„ars n,u reme� � oate (monm. dar. r�e�)
FWI resitlent addr�s of applicant (nu Der,nd sl�ef, riry. slate, and ZIP oode)
� '1 a � ' ' _ '
cy
Person aWroraed Gy G�Ay ezecuted Power alHttomeY � M IC 61.1-12-0.7 .. ., Date (rt�orW�. EaY. lear)
Pddmss W auUrorrzed person (number arM sneet dty. slate, and LP cotle) .