HomeMy WebLinkAboutMortgage_Rodgers"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownshi Year �
__ = FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709IR71 / 6-09)
�' l PresaibeE by DepartmeN W Laal Govemment Finance
File Mark
INSTRUCTIONS:
To 6e filed in person or by mail wifh the CountyAUditor or Counry Recorder oJ tAe counry where the ploperty is located. �
F7ing Dates: 7) Real Pmperty: Must fila dunng Ne year for which fhe deduction is soughG �J Auditor
2) Mo6Be / Manufactumd Homes not assessed as Real Property Must fJe dumg the nvelvu (12) months
befae Maich 37 of eech year the deduction is srought. ❑ � ���
See rever� side toradditional instrucrions end quali�irations. ���BS � _
������� �
Marh 1. anrnt SPar
/
i ro. what is h's I her e�md share ot Interest?
If rartie af 2cwd'a SAterent V�an Nat of aPpOrant, cid'u
Name of mort9aBee ar mnbaG sHler `
� A1
Pddres W mart9a9� ar mntrad seDer (nuMUend sL
Name of assignee w otM! wmer or holder af rtnrtgage
AOCress of assiqnce (number aM stree4 a1y. slete, ana
ww�+�+�
-�- c�. 7c�3 -�a
I Contraa intlebtetlne5s unpaid 25 ot Mortg39e I COntr2i
V�9:Y��ir _ . date ol aPO��
sbfi. arH ZIP aode)
aCe)
Is Ne appliont Me sak
legal w equkade rnme(1
❑ Yes ❑ No
rc ovn,ea win, samearre ather than spoiae. inaicate witl, wMm
6 tM proprJty in Vu�oon: MmiaAy /�sesud
�eal RoPertY Q Mnually Assessed
Dp¢s apduant wm poperty in any oU�er I If yes, wlat oountyt I What Tad�g DisviU7 I Has Ihis deEUrfim Eeen requwted m p�operty
munry in IMiana? ❑ Yes ❑ No ��� �n ❑ Yes
❑ No
/ COUNTYAUDROR
Deduclion in Ihe nt oE � �
20 _ 20 _ 20 _ 20 20 _ 20 _ 20 _
5g�me d CamHAUtlitw Counry Date (mwW. daY.Y��
1/ We certfy urWer ihe penatty ot perjury that the above and foregoing infamalion is true and corre�3 arW Nat the applirant is a resident of IrWiana aM
owner I contrad b�yer of the aforementioned pmperty��ate application is filed. �
$�9n re IA�*lai �+ND�I/1 _ 1 _ / _ . _ Date (rtmtli. daY. Y��)
Cy CWY
ce�
�
� �/'l3.7%
dry, s!a(e, an0 LP ootle)
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