HomeMy WebLinkAboutMortgage_Will^' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
__ - FOR DEDUCTION FROM ASSESSED VALUATION
. . " Stata Fortn 43709 (R71 / 6-09) '
�' ,,,, � aresainad ey DeaartmeM ar Laml covemmem Fu�ance
�srRUCnoNS: rt�np �,,f1,f1
6e filed in person a by mail wifh the CountyAuditor or Counry RecoNer o! the pounty whe2 the properfy is located. G l. il� L�1 �
Filirg Dates: 1J Real P/operty Must fife durirg the year for which fhe deduclion is soughL County Auditnr
2) Mo6de / Manufactured Homes not assessed as Real Property: Mus! file durirg the twelve (12) months .�.
be7ore March 31 of each year the deduction is sought. n Remdu
See reverse side foradditional inst�uctions and qualifications. DITOR
Appfuam (ownei a tontracY buyer - see re5ririnrss m reverse sde) �.
� � . r� r� �7 (� �_ i .. �
as w
m
ro. wha� is his I her exacl share ol interest?
-- ���a- � -
e/ Contraa Intlebte�ness unpaid as o( Mortgage I CmvaC
, wrtem year date of appGatmn
If name m reard'a tlilfuen[ than Ihat of app(icant, udicate bebw.
r��,e m �mvas� �
mohgagce or mntrap se0er (numbar and stree4 ci(y. sfafe, aM ZIP code)
signee w oNer owner or hdder ol rtprtgage
Adtlress of assig�e (n�mber an0 atreet ml: sbte. and ZIP tode)
Dces applipm ovm property in any aher I It yes.
munty in IMana? � .. �jQ ..
20 � 20
I numbu Page rwmber
�ll S
as d is Ihe aDP��t ttre sde
legal eWitadeameR
� Yes ❑ Na
If wrtred wiih someane aher Ihan spouse. i�wate with
COUNTYAUDROR
20 20 _ 20
Caunry
yCi�e MoPenY in q�: Mua�aOY A�seO
y�eal RoPertY ❑!4!muallY `Asess�d„_ _
..a
Drarvcr NO..� ��..........
Card NO. `��y
.....................
� I la,(�0.� ' `��al�'�,dw�.9n� ,
Pi���:�'
'�]
I I We certity under �he penalry of perjury Nat the above arW foregoing infortnalion is We and correct and Mat Ne applipnt is a resident of InEiana arid
owner / wntract buyer ot the afwementioned D�nY � date application is filed.
iraturAlowne/s �iNi�ppe) Date (�onN�. daY. Ye�
tily, state, and ZfP ootle)
Person auUror¢eE Cy Euty ezecutetl Power of AtlqmeY or Cy IC �1.1-12-0.7 I Date (monN. daY, yea�
P4dress o1 autlwmcd persa� (numbcr a� stree; dry. sfafe. ard ZIP oode) .
,