HomeMy WebLinkAboutMortgage_Vincent (2)'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ • FOR DEDUCTION FROM ASSESSED VALUATION
l ,� Slate Fortn 43709 (R71 / 609)
�' Presaibed by De7a�N of Local Govemmenl Fi�anca
�NSTRUCDONS: �� J
To 6e filed in person a by mail with the CouniyAutlitnr or Counry Recorder o7 Ne county where the pm�is
F7mg Dates: 1) Real Pmperty: Must fi1e dumg Ma year for which the deduction is sough[.
2) Mo6de / Manufactured Homes rrot assesced as Real Property Must file d�nng [he twefve (72) ng�jFjs O�
6e(ora March 37 o7 each year the deductbn is sught. MNl
See reverse side lor addi[ional instmcGOns and qualifications. ^�' -t
AsesseC vaNe d rpal p(opertY aS ot � n
A18tti� 1. �tma�t'/e� �
rc no, what a nis � ner ezacc shara ur intemst?
If name m remd is dlftemnt than ihat o( appGcant,
AEEress of mort9a9ce or contrac� se0er U
Name o1 assiy�ee w other ownet w hold�
e
AECress of assignee (number aM svee4
Does apptimnt own poperty in aery aher
tounryinlnQ'ana? ❑ Yes
1
in ihe amount
of mmgage
:/ Contraa 4Webtetlness unpaid az of
Wrtetrt year
aty, srare, ara ur aooe�
aM 21P code)
��m i�
ti�Ebid numher
o, a
��a��
Counry Auditor
County Remrder
Page
Y� u No
someone aher Ihan spouse. iMimte wM whom
Is ihe property in pue50on: Mnua��y A.rsxA
C7Real PropeAy ❑ ArmuaVyASSessed
i Mohle Hort�e (IC 6
Dra���er NO...°.�.��,�....... j
Card NO. .. �5•�....... —
20 20 20 _ 20 _ 20 20 _ n1 _
��wre d Camb nW'rtor Caunry oate (momh. daY. Y��
I I We cerUfy under the penalry of perjury thai the above arW foregoing infortnalion is we and mrreU anE Nat the applicant is a resident of Irniiana ard
owner I Vacl buyer of the aforementioned property on date appfication is filed.
._..... .. .E. F ,.�,�e� 1 / . � Date (month. daY. N�A
I resig �nt add of ap�rant (number and SLect, dry, state, arrd ZIP ootle)
� d��3 c��r �P(�YYE'�C�`�
P authaaeE Oy dWy execuuC Pwer of Attanay or by IC 61.1-12-0.7
Atltlress of auUror'vE0 De� (numOerantl sbee; ciry. state. an0 ZIP code)
tlay, yea�
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