HomeMy WebLinkAboutMortgage_Bilderback^^n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS hi vear
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Fwm 43709 (Rtt / 6-09)
S , Presaibed Ey DepaNreM af Local Govemment Frarxa
� ark
�STRUC710NS:
with:
be filed in person w by mail witA the CountyAWitw or Counry Recorder of the county where [Ae property is Iocat�U.' '
Filing Dates: 7J Real Pmperry: Must file dunng Ne year7o� which the deduction is wught. ou[�pr Auditor
2) Afobde / Manulactured Homes rrot assessed as Real Property Mus! file durirg the tweHe (121 lQO1��� CO N U DITuFi
6efae March 37 01 each year the deduction is mght Glna County Reoorder
See reverse side (or additronal inshuctnons and qualfications.
Ma�(����_n b� q— re/�d". ...���J ��/9C 1. nAi7 n o� _ G
As�sse�rdue cf real p�apatY as of
M� 1, a�i ytlr
If ro, what 5 h¢ / her exad sha�e of intcresi?
11'ume m remd'a Ciiluent Nan ihat ol aPp
IJart�e of rt�ortgagee or mnvaU s�
C
ACtlress of rtwrtgagce or mntred
Name ot asv9nee w o�er owner or halEer o( mortgage
S� �
unpaid as ot
%
cify, stete. aM ZIP code)
Adtlre55 of ass9ne¢ (num6e� aiM sUee4 Cuy. state, antl [IY cotle)
Dces appGmnt ovm property in anY ot�er If yes, whal counq/.�
munryinlnOgna? ❑ No /
❑ Yes
app�wed in 6ie arro�n[ oE
YVlizt
Remrd numbg
unpaid as d
Page
snt Ne sde
iilatle owneR
Yes ❑ No
mmeo� other Man spouse, iMicate with wlwm
Is Ihe P�VQnY in 9uesbon: MrwaOy AssesuE
ea� Proaertv ❑ amuaiyassessed
Dra�r cr \'O.. aU.� �.........
55i 7
Card NO . ..............o......
� I 33,� G°--
. �
Y
No
20 20 20 20 20 20 _ 2tl _
nanrte o( CambAUEitor Counry Date (mavh. tlaY• Y��
I/ We certify un0er �he penalry of perjury that the above and foregning in(ortnation is We and cortect a`M ihat the applitant is a resident of Indiana aM
owner / wnVact buyer of ihe af m tioned perty on date appliralion is filed.
inalure ownefa N9 / Date (nmN. daY. Yea�
dent adOr�s of applipnt (numDar and���. �t rny, sbte, and ZIP mtle)
ba- ('%nic.kASA�I% �)IL�u� �o
auftomed Dy tlWy ezecute0 Power dAUOmeY � M IC G7.1-12-0 7
� of aWmr'v.rd person (number arM street, ciry. state. an0 ZIP oode)
o� ��,rn. ear, r�