HomeMy WebLinkAboutMortgage_Stackhouse""* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yea
_, ; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fwm 43709 (R71 / 6-09)
,,,,, J Presa�bed Cy Department of Local Govemmenl Fnance �
F a
INSTRUCTIONS:
To be filed in person w by mail with fhe CounryAUditor or Counry Recorder oI the county wAere the pmperty is located. Fortn meE wiN:
Filing Dates: 1) Real Pmperry: Must fi/e dunrg the year (or wbich the deducfion is soughL O C T 1 yC�tO �unry Auditor
2) Mobile / ManuFactured Homes not assessed as Real Property Mu51 file dunng the fweNe (72J months
befae Mamh 31 of each �❑ Caunty Recorder
year Ihe deductvn is srou;7hf.
See reverse side 7or additional instrucLOns and qual�cations. �%a� r�
Appfrant(o rormntrarl6 r-s stricbonsrnmve si]e)
%%aA �%Se , c�- L L OIBSON COUNTY AUDITOfi
Key�trtnEer
o - a- -�oo -000. a
Assessed rWue of �eal pop as o! Mo age / Canbaa intlebt/ed'n�ess unpaid as of
Memh 7. ar�art year Ma eirt �°, `X J
�
II ro, what a i� I her e�d share of inf�t? tt wrta
name m 2md is diffuent Nan tlat W aDO�+l "uidipte EeloM-
convact
of morigagee w mntraci sr�er
Name of assignee w othr! owner or halder ot rtartga9e
rdy, sbfe, eM LP cade)
AEE2ss o( assignee (number aM stree; tlry. state, and LP code)
Dces appli�ant am property in any oNer
munty in IMiana? � _ _
�a � �
I I We certify under ihe penalry of
owner / contract buyer of the�r
�raWre (ownerY fiAreme) . �
�
� - voc
tgage / ContrarY uWehtednes
; of appfi�tion
someo're ather than spouse.
Page number
unpaid as of I IS �he applirani Ne Sole
legal w equilade oxnd!
� Yes ❑ No
pnrty in Vunstion: MrwaOy Assessed
PmPehY ❑Mmua11YA��d
hbWle Home (IC 6
� � / — _ ' _�
Dra��•er N�...Q(,��. No
...... —
COUNTYAU[ Card \r0. ..., ����
zo— �15�,�1�.� —
Counry Date (nmth. daY. Y'�h
the above fo oing infortnalion is We and cortec[ and that the appiicant is a resident of InEiana antl
pro Plication is 51ed.
Date (montlt. daY. )va�
ro-o�-09
ident adOres ot appGtant (numDer anE� f, ary, state) and Z1P mtle)
C51�1 E. ��D S. I r,nce?o.� 1�J
autlarized Gy duty executed Power ol Artorney ar by IC 61.1-12-0.7
person (numberaM sbee4 �y, slaR.
o�e ��nn. eay, res.�