HomeMy WebLinkAboutMortgage_Thompson (5)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n n hi Year
_. FOR DEDUCTION FROM ASSESSED VALUATION
:• State Fwm 43709 (R11 / 6-09)
� � Prasai6etl Oy DePa�r�t of Loral Govemment Fu�ance
INSTRUCTIONS: MAY �Fi� t�l�
Fortn Ned wBh:
To 6e filed in person w by mail wiM the CountyAUditor or Counry Recortier o/ fhe oounry where the property is located.
Fitirg Dates: 1) Real PropeRy: Must (de dunrg the }rea� /or which Ne deduction is wughL `Yn unty Auditor
2) MobAe / ManulacNred Homes not assessed as Real Properry: Must file dunng the twefve (72) monN� ��
6e/ae Marth 31 0/ each year the deduction is sought. nry Recorder
OIBSON C UN AUDITOR
See reverse side /or edd2onal instnictbns and qualifications.
Aod'rant (awirerar roY2C buver - aee restcUiwis m reverse sidel
Ta ���' ,,pppistruY //� Key rwmbrr
� (/
�rah�edrealPmP aso( !
A/e'rh 7. arivrt yw !
tt rq, whal $ tis I her e�1 sture Of intetest?
H nama m racnid "n CiRe2nt Nan ttut ot aDP��t
Name of rtartgagee or mntrart seller
-ia -iaa -� /. o i 6 - o
/ Contract WebteOn¢s unpaid as W Mongage I 1
rtnrogagee or contraa sr�er (num6ei and streef, riey, slam, eM LP code)
If wmed with smr�eone aher
rvame ot assgnee w amer ownet or naaer m nmgage
AdC2ss ot assignee (numher and street �: smte. and LP catle)
Dces applifant ovm property in any oUer If yes. what wunty.+ NRat Tam
munty in IMana?
. n Q Yes ❑ NG
� -/U -
couNTrau'ortoa
DeducOOn aGW� tr� tlm amount ot
20 _ 20 _ 20 _ 20 _ 2b
Sig(anrte W CamfY Aud'enr _._ � Counry
Rewrdnumbu PagenumCu
a 33
�.bieCness un7aid as d Is Me aPP�mant tlx sde
legal a eQuitada owne(i
❑ Yes ❑ No
sPouse. 4d'icate with whom
Is ihe property in QuesUOn: MnuaDy A55e55e0
�eal Propc'ny Q Amlua�y Asse55ed
Alodle Hame (IC 61.7-:
Dra«�er NO:... a��..�....
Card NO. ...... ��.��....
� a`�, 7QCo . cS�
20 � 20
1 I We certfy urWer the penalry of perjury Nat Ne above and foregoing infom�atlon is We and correc[ arM that the applirant is a resident of Indiana and
owner I mntraa buyer of Ne aforementioned property on date application is filed.
Sq�¢Wre
Fu0 resiCeht add�s ot appfranl (nunlb
� aysti E so N
Pe�..on au4roRed Oy OWy executed Por
�
arM sLaeL tlty, sfate, arW ZIP coda)
person (num0er aM sheet ary. sbfe, and LP code)
5 - �`/- 20/U
o�� v�rn. ear, r�ed