HomeMy WebLinkAboutMortgage_Page"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C n o ns Year /7�
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (Rtt / 6-09)
, ` Prescribetl Cy Deparimenl of Local Govemmenl Flnance
File Mark
INSTRUCTfONS: C �
To 6e fli ed in person or by mail with the CounryAuditor or Counry Recorder o! tAe counry where the property is located. � ��
FiNrg Dates: 1) Real Pmperty: Must file dunng the yearlor which Na deducfion is waght. ry Audimr
2) Mo6i7e /Manufactured Homes rrot assessed as Real Pmperty: Must file dunng the Iwehre �StQMI{�sOU N I'lr�
before March 31 of each year fhe deduUion is stwght Counry Recorder
See reversa side lor addifmna/ inshucGons and qualilcations.
/ ( f � // �
Tari i ' Key fwmb
w
a6-
n�es�ee � d� c�,, as m
MaRh 7, asmn[ year
If rq. whet is his / her eYaU shara ot interesl?
If name m temN's dfiuent ihan Nat o( appbca
Name ot rtnrtgagee or mnVaG seller ,�
wrtenlyPar
Addres ot rt�ortgagee w oontract se0er (nurMer end street �1: s7ate. artd ZIP code)
ot ass'gnee or other owner w hdder ot morigage
s1me4 ciry, s+ate.
Does appliraN o-xn property in any oUier I If yes.
counry in Indana? ❑ Ye5 ❑ No
pion aOP�'� � � amwnt ot
20 20
Si9�Me at Cwmry Autlitnr
20
C�3:��
Date
If rnmed wBh somewre WMr Ihan spouse,
Remrtl number Pa9e numbrl
U (� /
wpaiG az o( b Ne app6�ant Ihe =^�°
lepal a equitahle a..rel7
❑ Yes ❑ No
Is Ihe pmperty in Queslirn: Mnually Assessetl
�eal Property Q Arrtivally A�
Dra���er \O. �� �•� .........
I �p51
........
Card \O . ...... ......
COUNTYAUDROR h /��'��j-I.�U _
R
20 20 20 20
Caunry
Date (month. deY, Y��
I/ We certify under Ne penally of perjury that the above arW foregoing infwmalion is true and cortect and Nat the applirant is a resident of Indiara arM
er I contracl buyer of Ne afomme � erty on date appliption is filed.
➢� (o eYs lull name1 Date (monN, tley, yea�
� ._.-. `� . � .� . ' ��P 5'� - � (
e�„!.� .I'�S�
state,
1�
PGtlress of aWror've0 person (numbera�M sLee4 Gry. stare, antl LP code)