HomeMy WebLinkAboutMortgage_Memmer'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
.r __ < FOR DEDUCTION FROM ASSESSED VALUATION
� Stale Fortn 43709 (R11 / 6-09)
,,�,� � PrescribeA bY �Pa�nl of Laal Govemmenl Fnance
VSTRUCTIONS:
o be filed in person w by mail with the CounryAuditor or Counry Recorder o/ Ihe counry where the property is located.
Fi7ing Dafes: i) Real Pmperty: Musf file dunng the year /or which [he deduction is sought.
2) Mo6ile / ManuFactu2d Homes rrot assessed as Real Property Must file dunng [he tweNe (12) months
befwe March 31 of each year the deduciion is sought.
See reverse side for addi[ional instmcfions and qualfications.
npp�cant (owner qcynntra � er - see restrrc�pr,s�n reverse side) / � / � � �
��t �, i
��Miv n�.,.l if...�� / //i n., nn'Y7
�is�.-�- - �-
pment year
If no, what is ha / her e�tl share of interest?
If narne m record is d'Aferent lhan ihat of applicant, i�Minte bebvr
w wntract
Fortn filed nwith':(�
�E� 11CQ�M�Auditnr
NTY
- kecord numbu Page number
� oa // ( `��/
7e / ContrazY mdeMetlness unpaid as d Is Ne applirant Me sde
applintion Iegai or equitable ownM
❑ Yes ❑ No
If owned wiM someone other than spouse, iMirate v.ith whom
Name of assignee or other owner or hdc
AECress of asvgnee (number antl street `^" '� (.�(�t/ �{- ��u'/`�'
���J� v /y� �y/,�����
�es applirant ovm property in any oNE � J�� /� � ��� 1Ll/� � �" �
munry in IrWiana?
❑ Yes
amount of: � �—� � `� I
20 20 _ }P �W� O(,J � �
SigrahrteofCounryAUEitor �y�u.. __ l�in ' . //'��r���'µ-(.i%� �
v :.in��cxt.vL t
I/ We certify under Ue penalTy r� �'��� 1 '
owner / contract buyer of �he 2
$ignaNre (owne/5 fiAI rame)
stafe. aM ZIP code�
executed Power of AttameY ��' IC G1.
Pdtlress of authw¢ed person (number aIM sbre4 �: state,
Is ihe property in puestion: Mnually Asse55eC
❑ Rea� Propertv ❑ amua�ryAssenea
I Fias Na detludion Eeen requested m Ploperty
for wertnt yraR
❑ Yes ❑ No
_ 20 20
Date (rtanN, day, yea�
xrect and that Me applicant is a resident of Indiana a�W
Date (rtonfh, day, yea�