HomeMy WebLinkAboutMortgage_McEllhiney (11)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
r__ = FOR DEDUCTION FROM ASSESSED VALUATION
• SIa[e Fortn 43709 (R71 / 6-09)
�' P Presmbetl by Deparimenl of Lorel Govemment Firance
� Fil a
�lSTRUCTIONS:
ro be filed in F�"� ���
person w by maii with the CounryAuditor or Counry Recorde� of the oounty where the property is located. 'n''
Fi7irg Dates: 7) Real Property Must file durirg the year fir which the deducfion is so�ght. � �� t�ty q�ditnr
2) Mo6de / ManuFaUUred Homes rat assessed as Real Property Must file d�rirrg the twelve (12) rtwnths
befae March 31 ot each year the deduction is soughG C ounty Recorder
See reverse side for ad¢�jronal instructions and qual"fiications_ V C\
T2ti�yDis O� I Key nu
�i/'
w� �d,e a rea� �mi � d
MaiGi 1. aarenl ye.ar
I! no. what is his / her exxt share ot interest?
It ranre m�eard "¢ S�Rerent ihan ihat of apW
Name oi mort�agee or convarl seller
COUNTY AU
rTlegal de9qipcyan_ /� __n(?� �va b33-Gr�7 Remrd num�/ Page numO��
(,Y !Q v7 � I
hbrtga9e / Contraa irdebtetlness unpaitl as of Mwtgage / Contrar3 uWehtedfress unpaid as d Is Ne appinnt tlre sde
Ma�ch t. artent y�c., , I ._ � da[e of app�cation legal n'�e awnrY?
� I Ttill J n No
PGdress ot mortgagee w contraU seller (numbu and streef, crty,
Name ol assignee w other owner or hdder o( mortgage
ACCress of assignee (num6eraib streef, ray. sfete. entl
Oces aPWipnl ovm proper
counry in Intliana?
�
olha
� Ye� No �� � �� �
rnG ��W�� �
� �- (�D3d
I/ We certify untler Ih, _ ��ec tf(e above and (c
owner / wntrac2 buyei��i me aforementloned property on date
�nanire (owne/s hN name)
F rt�ent address of app4rant (numDCr and SLeLR. tlfy, state, antl ZIP oode)
3/oS. /noE ��6�. �- `/7670
Person aullro�rzed by E�iy ezerL:etl Power W Atlaney tt by IC G7.1-12-0.7
person (number arM sbeey dry. sfate. aM ZIP cotle)
�f owned with someone oNer ihan spouse. iMrare wM xMm
Is the PmPert1' in Cuestion: MnueM Assessed
❑ Real ProPeAY ❑ Mnualy AssesSed
Has �ha tleCUUion Ceen re0ueste0 on P�Y
ror arrent yeaR
❑ Yes ❑ No
'ROR
zo � zo _ � zo
,.niry
informatlon is We and wrtea and that Ne applipnt is a resident of IrWiana aM
ion is filed.
Date (rtarnfh. daY. Yeah
oaee ��r�rrcn. eer r��