HomeMy WebLinkAboutMortgage_Callis•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship Year
= FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709 (R17 / 6-09)
` PresaiOeC M DeP�M of Lttal GovemmeM Fuwce
�vsraucnoNS:
To be filed in F� fl� ��
person or by mail wifh the CountyAudiror or Counry Recorder o/ the county where the property is located.
Prl'mg Dates: 7) Real Pmperty: Must file dunrg the yea� lor which Na deduclion is soughG O C T �� �, �ditor
2) Mo6tie /Manufadumd Homes not assessed as Real Properiy Must file dunng Ne twelve (72) mon[hs
6efore March 31 of each year fhe deduclion is sought _�. Recorde�
See reverse side (or addiGOnal inshuctions arM qualilcafions.
MV�RtfG�ror wntrad b�Yer - sea m�fptlions on raverse stle) I
Ass�sse0 raNe d 2al pape
Iamh 1. amenl year
It ro. xRat a his I her ezaG
If �rtie m �emrd 6 QAfbPl
Key rvunber / legal desviption ReMrd number
2�-��-� - 302.0� �� �-oa (o a
Mortg g / Contract irde6ledrress unpaid as of Morigaye I Convaq mEebtednrss �mpaitl as of Is Ihe
archateafrentyear dateotappfi2tion legal
Od
;teresl? If owred wiC� sameore Mrer Ihan spouse. indimte with whom
tlat W appGCa�rt, trMifate Eebw
W mortgagee p mntract seller
ACEress d rtiortgagee w
Name o( assi9nee or
ari seDer (numDer and stree4 �dY. s+a�e.
ner or hdder M rtwrtgage
aritl stree4 �}: slate. and ZIP code)
Dces applifaM ox+� ryoperty in any olher
munry in IMena?
❑ Yes
Deduc7on approued'm tice art�nt oE
zo zo _
SigreWre of Cmmry Aud'ROr
If ye5, what
iita6le owne(t
Yes ❑ No
Is tM prope�ty in QuesUm: Mnua�y Assessed
�eal Property Q PumuaOyPssessed
��..�.;e u.,..,e nr a
/
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��„� Dra�r�cr \0 ...... ...........
� C11'(j �i�. .... �.0� �.....
20 � 20 - � _
ca,�y
� P�Y
❑
ro
-- , _ _
I/ We certify under the penalty of perjury Ihat Ne above and foregoing infortnalion is true and cortecl arM Nat the applicant is a resident o( Indiana ard
owner I contracl buyer of �he afwementioned property on date applicalion is fiied.
�nahue (owrrefs !u0 name) (� /a n.. r Date (rtwttA. daY Y'��
FWI r�tlenta0tlfes�yW apprcam (numDer�
r� �fo ti�" T S.� i
Person aWnr'¢ed Oy OWy ezecuteA Power
Address of autha'¢ed person (numbe�arc
slafe. and ZIP oode)
�y rn by IC 61. V12-0.�
�y, stare, antl LP mde)
Date (monN, daY• Y��