HomeMy WebLinkAboutMortgage_Reinoehl^'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
• Stale Form 43709 (R77 / 6-09)
, 1 Presaibetl q' �epartrtrerd of L�I GovemrtreN Firence
e
INSTRUCTIONS:
Fo�fiqd
To 6e filed in person a 6y mail with the CountyAUdiro� o� Counry Recortier o/ fhe county whe2 the pioperty is located. E J V�9
FiRrg Dates: 7) Real Property: Must file dunng the yrear (or which the deduction is sought. � Counry Audimr
2J Mo6de /Manufactured Homes irot assessed as Real Properly Must h7e during the fweNe (72) months� �
before March 31 0/ each year the deduction is sought ounry Recorder
See reverse side !9r adtlitional insfrticti9ns and qual�9ations. OIBSON (:n
^ UN�Y
MP��t(owna� �-see re sde)� � _ � . _ _ . �IIII�T�� I
I(ey
�������
Mazrh 1, amnt year
If �w, �Mat is his / her emG share ot interest?
If name on 2croN a
Name ot mMgagre p wntraU
- i � -�-oo - o� - 19y--aa o�
pqtrd� "mdehtedn�s unGaid as of tl te of ap�catbn inAebtedrress unGaid as d �al a
�R�1'� i^ ���
mntraa se0er (numbe� and sbee4 �y. sbm, aM ZIP cade)
Name of assignee w other owner or halder ot mortgage
AEdress ot as4gnee (number arM stree; tlry, slate, ant
Does ePpli�nt wm property in any oNer
munry m Indma? ❑ Y¢s
❑ No
DeducCOn appmved in Ihe amounl ot
20_ 20_
I I We certify uMer the
owner I con4act buye�
�taNra (owneh hID ..
�I resWent adtlr�ss ol aPpG
�FS�'3 ,.� /�n
rlon auttnraed Dy Outy ex
of perjury
anC
_ iei�o�hl _
Z/P a
I(yes. S� -^ .
u ��
= 513� g��s�� _
Page
Yes LI No
Is ihe property in purstim: MnuaOy Assessed
❑ Real Property ❑ ArmuallyASSessed
Modle Fiortie (IC 6
Has Nis deEUCim Deen reGUesteE an P�Y
ror currenc yeaY? �__ �,
2p _ 20 _ 20 20 _ 20 _
Counry Oa�e (nanffla�year� � �
( �J
e above antl foregoing intormation s we and cortea and that the applipnt is a resident of Indiana arn
roperty on date application is filed.
\ Date (month. daY• Y��)
a
person (numberantl sbeef, dry, stafi, aid LPCOde)
o� c,�«�m, aa,�.
/