HomeMy WebLinkAboutMortgage_Michel^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co wn ' vear
_ + FOR DEDUCTION FROM ASSESSED VALUATION
� Stata Fortn 43709 (R17 /6-09)
�' � Pr�aibed by OepaRmeM of Lacal Govemment Fuance
File Mark
INSTRUCTIONS:
�Fortn vnth.
To 6e filed in person or 6y maii wiM the CounryAuditor o� Counry Rem/der of the counry where the property is located. •
FiNng Dates: 1) Real Pmperty: Musf file during the }rearlor which Nie deducUon is soughf. � Cou ty Auditor
2) Mo6ife /ManWactured Homes rwt assessed as Real Praperty Must file during the tweNe (12J months
be(ore March 31 of each year the deduction is sought � Re[arder
See reverse side !a addilionel inshuctions and qualifications. G IBSO
MWiwm(owneraconrrartbuyzr- resvirb'onsmre��.x�rse�si�de/) �
i i„"'�11..Q���
Tab �' ficY _ �wmbu / eun Remid number Page numbu
�
m, what's his / her exa(Y share of intrlest?
-ia-o3_ oo-000. a�-od� o0 7
Mw(gage I Cantracl'vWebtetlness unpaitl as of Mortgage I ContraU inOebtedness unpaiE as d Is Ihe eppfirant Ne sde
Mart�h 7. airtenl yeer date of epp6mtion legal w equitaOle ovmeR
� � /1 n/l /i ❑ Yes ❑ No
If twrie m mcrnd'a Eilferent Nan Ihat o( app6rant, mtlirete belm�c
Name of mortgagee a convaU seller
�d����
(number aM atreet, rdy, steta. end ZIP coCe)
Ooes epplimnt ovm prope.rty in any other
munry in Irid'anai ❑ YC5
�^Of.^,^
20 I �
If owned wiN someone other than spouse, udimte with whom
S
�>
If yes, what muny.+
'
COUNTY�
Is ihe properiy in Questirn: MnuaDy Psstsse0
❑ rxe� �oPenv 0 nnnuany w�ss�d
Dra���c►• \O.� D..`.'..��....-....
Cat'Cl \�. ...�D.!.°.�. 7......... �,,,v�m
5 ❑
2Q _ � 20 _ � 20
Counry
20 _ I 20
J
� Date (monN, CeY.
I IWe certify under Ne penalry ot perjury that the above and foregoing intortnatlon is true and cortec[ aM that ihe appli�ant is a resident of Indiana and
owner I contraa buyer of the atoremerrtioned property on date applicatlon is filed.
Full
rc�o rv ��N(i�ON
exewted Po�m1 al Attomey w by IC 61.1-12'
Mtlress ot author'veA person (number and sheet, tity, state, aM
�/�
ear. r��
�Y �