HomeMy WebLinkAboutMortgage_Sturgeon (2)'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�r=—
= FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R71 / 6-09)
� j Presaibed by DepaMient ollocal Gm�emmenl Fuaxe
�ww..������ � F
STRUCTIONS: �d
be filed in person w 6y mail wiN the CounryAuditor or Counry Recorde� o/ the counry where the property is located. �E ��/ �2 � ��
Fding Dates: 7) Real Property: Must �de dunng fhe year for which the deduction is sought. L j Counry Audimr
2) Mobi/e / Manufactured Homes rat assessed as Real PropeRy Must file dunng fhe fweNe (72) monfhs
6efore Marth 37 0! each year the deduction is sw�9ht _. Recorder
See reverse side for addifional insfructions and qualifications.
nI (ownerar contraa buyer - s resfn'rb'ons m reverse side)
Ta ' Distric[ Key num legal desaiption Remrtf number Page num6Pi
a-�'�� -la-� - oo-ooa. . �09-0�� j�ol l
Assrssed vdue d real propnty � of Mortgage / Contract intlebtetlness unpaid as of Mortgage f ConNUY indebteAness unpaiE as o! Is Ne app6ran[ Me sole
Marr3i 7. asrrnt year Mamh 7, wrrem ��ear date oi aOP��+ � w equitable owne(.+
� aQ OQjJ ❑ Yes ❑ No
I( ra. what R ha I Irer eaar� share O(
If rw�re m remid a dAlemni Nan that of appfwant, mGkate Gebvr.
Name o( nWrt�a9ee or contraU 5eller
mwtgagee a
Name
„r ,'.rc-�•!'➢
aid
AOdress o( assignee (numher and stree4 �1: slate, end Z/P coCe)
7 aE _a-�o
Dces appliram oxn ryoperty in any other If yes. what counry7
tountyin Indiana?
❑ Yes ❑ No
sorneone
,5�39 � �
NRat Taviy D'str�?
15 Ihe DbVertY in puesGOn: M(wa0y fv�ses5ed
❑ Real Properly ❑ Nmually0.55essed
Dra�ti�er Np,.a.2.o �/_
Card NO. .....6��/
...............
Has Nis amw....�'"
fOr wrtent yeaR
❑ Yes ❑ No
GOUNTYAUDROR
IDeEuclion appoved in fhe amount oE
20 _ 20 _ 20 _ 20 _ 20 20 20
Sigreture of Caunry Autlitw Counry Date (month. daY. Yea�
G� .T. —
I/ We certi(y uMer ihe pen of perjury that e above aM foregoing infortnalion is We and cortect afM ihat Ne applicant is a resident of Indiana aM
owner f mntract buyer of Ihe afaementirn property on date applicalion is filed.
` Si9�nve name) Date (month. daY. Yea�
1
Full ent aEdrass of app�rant (number and streef. ary, state, antl ZIP aotle) �
'l� y.s� �- cR s� s �.n�Q-�..,. z� 1 �6 ��
Person auNOraetl Dy Euy ezecu�etl Power of Mtaney w by IC 61.1-1Y0 7 Date (monN, day, yaa�
AdER55 0( auNar¢ed person (number aM SLee( Nly, stafe, and LPmde) _