HomeMy WebLinkAboutMortgage_Whitehouse"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
; FOR DEDUCTION FROM ASSESSED VALUATION
State Farm 43709 (R71 / 6-09)
�' �«. � P�esaiEetl M DePaNneM of Loral GoremmeM Fnance
INSTRUCTIONS:
To be filed in person w by mad with the CounryAuditor or Counry Recorder o( the munry wheie the property is located.
F7ing Dates: i) Real Property: Must file durirg the year /or which fha deduction is wughG
2) Mobde /ManWactured Homes not assessed as Real Pmperty: Must file during the hveMe (72) months
6e(ae March 37 of each ysar the deductlon is sought.
See reverse ' e lor addrtional instn,ctions and qualificatrons.
Appfxan� ( r mnlrarY b - see re�.xrse side)
Year
E�]7 ��9k�a�
LJ �+nty Recorder
Iw GI°SON COl1UT. Y F.U9ITOF?
�D. . �� I) nl'� OD ��� � Qg`Q� 0���� P.�O
Assessed vdix d m�d pmperty as of
Ma�Ui 1, aneni yrar
1! M. Wh816 hl5 / hPl GYdq 51f21B Of VI}¢fFSI?
tl nalne af �cotd'a EiRemn Man that of aPP�
n
ga9e / Contrati IntlebteEeress unpaid as of Mongage / Cantracl umtlebtedness unpaid as of Is ihe appGranl Me wk
� 7�{^�' I year Eate o( appGption legal v equRade ovmeYl
�[ " � � (Y%�� ❑ Yes ❑ No'
Address W rt�ortgagee w mntrad seAer (numDer end shee; rily, sfafi, aM LF�de)
Name of assignee or oihrr ovmer m hddel.of rnortgaga
MEress o7 assi�ee (num6er an0 stree4
����rsE iPe-.4� S
Ooes eppliont w�+� property in any oNF �
�,�vr��i��� ❑ re� �N,IJi�,B�
���,�����of aa�o-���
za i� i�_ i 20
Y?
eza
SPOIlSB.IMM2SB WIGI WIIORI
�S I�IC PfOPEfiY III QUESbOl1: /YIf1110%�
❑ Real PfoPe�i' ❑ �^!!��Y �
Has ihc deduaim Oeen `eQuesteE m P��Y
tor wrtent yea(.� r� .. r� .
Zo— i �°—
�renne d Gamb Auddcr I Counry I Date (month, daY. Y��)
1/ We certify under the penalry of perjury Mat the ahove aM foregoing infortnalion is We end cortect aM that the applirant is a residem of Indiana antl
I mntracl buyer ot the aforementioned property on date application is filed.
� rowmers !W o�nel . . / Date (rtmth. daY. Y��
Cy dWy exE
� pr�mn
state. antl
sneeL uty. sfa(e. erd Z!P mde)
) �.
Date (rtronlh. daY• Yea+)