HomeMy WebLinkAboutMortgage_Mason"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun s p v r
__ : FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Fwm 43709 (R17 / 6-09)
�' ,,,, � Presmbed by �epartmeM af Lod Govemment Friance
File
INSTRUCTIONS:
Fortn
To be filed in person a by mail with the CountyAuUita or Counry RecoNer of Ne county where the property is located.
FrNrg Dates: 7) Real Property: Must ne dunng the year Iw which the der/uction is sought. Coun ' r
2J Mobde / Manufactuied Homes not assessed as Real Property: Must fiie dunng the fweHe (72) months �g$ [f�� NtyT�c
before Maich 37 0! each year the deductron is sought. CCaa�ny rc�TOR
See reverse side for addiLOnal instfuctfons and qualifications.
MP�N�a��9f wtonvaclQyYer - see msfrirliaas m reyersg side)
waessed vah�e d mal poputv � m
MaU 1, arma year
what Is his I her ezaG share of interesl?
on reca0
contraa seMr
ot assi�ee m othu ovmer rn holCer of mortgage
artentyeer
ah. sfate.
naaress o� assognce �numcer am suee; wy, sere, am ur coae�
Does aPplirant wm pfoperty in any aher If ycs, what munty7
m�^p'�i^c�? r-i .,__ n .,_
of
//
20 _ � 20 _ � 29 _ � 20
��
/ —U�G
as W Mongage / Contra mEehtedness impaitl as
date of appfiptlon
1/ owned wiN someo�re oMer ihan sPO��. indkate wRh Mrnn
f.il^1,^
epudade o.meR
] Yes ❑ No
Is Ne property in queslim: MnueOy AssesuW
❑ Real Property Q Armually Assessed
w„a�T��e� Dra�r�er NO c�Ql�...........
C11'C� \�. ...��.........
aUDROR
�rrs;000.�
2� 20 20
I/ We certify uMer the penalry of perjury that ihe above and foregoing information is W e and correcl arM that the appliqnt is a resident ot Indiana aM
owner I mntrad buyer of ihe afaementioned pfoperty on date application is filed.
panne (o /s lutl reme) y� � �ate (montlt. tleY.Y��I
.wia..✓ �.irC
!G� .� • J�T� KD /o � �jZrn.
i autM�rzed Oy dWy rsecuteG Poxei of Atmmey w by IC 61.1-12�.7
of aWmrQ.ed person (wmberanO sfree; ciry, sta(e, arM ZIP mde)
lti 4�6�a-��Z�
Oate (maRh. d2Y Y��
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