HomeMy WebLinkAboutMortgage_Chism"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
„, FOR DEDUCTION FROM ASSESSED VALUATION ,/
State Fwm 43709 (R7116-09) ��
�,,,, /. PresaiEeE by �ePartmeM of Local Govemme�n Firence
ile Mark
wsrRUCnoNS: /�'I �
To be filed in person or by mail with tlre CounryAuditor or Counry Recorder o/ fhe wunry where fhe property is loca e�.' �
Filirg Dates: 7) Real Property: Must file dunrg the year (or which the deduclion is sought. � Counry Audimr
2) Mo6ile / Manufauured Homes rat assessed as Real Property Must fiie dunng tha twehre (12J month�s � �nry Recorder
before March 31 oT each year the deduction is sayht. ��
See reve side foradditbnal insUuctions arrd qualrfications. TY AUDITOR
APPfi� wrier ormntrarf he.�er - see. mjbicnonun reverse sitle) 1
ii v i i
T�' ��.�.e�u✓ �Ya �., � I� 9-1 o I. o 0 0
A�sM �ahre d mal PoPab aa af Abrt9a9e / Conhau'vdebted�ras un0ad as al
MarU 7, artei4 Y� Marti� 1 arrnnt year
� � Q
rc �. � � n� � � �a �a�e or m�esn rc �
If tWne on rt,mtl's Cilfe�mt Nan Mal af app&an4 �C�te Deb'�'
Name M moriga9ee a mntraa uller � 7 / YLiL A
'1
Md2ss o( morqagce w mntrad se0er (nwn�e er
w
Name of assi5nee or other owner ar hdder M mpt�
ACera4s at a�gnea (num6er aM streeG rBy, smte.
Dces ePplhant am yoperty in any oNer
mukymindena? ❑ Yes ❑ No
De0uc6on sDProved'c� tlre amount of:
ae; tiy, smm• eM `
G
LP mde)
If yes. what tounf/.+
20 I 20 _ � 20 _ I 20
Autlitar
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ol-O 2-(0 o O " 7YJ
� o.gageaD�� indeMeMess unvaid as d � a� rn.+rll
❑ Yes ❑ No
someone oiher Ihan spouse. iMicate with whom
�+� mocertr m a�eum: n„mwnr assessea
�R'eal ProPertY ❑ �^�Y �
"� MoMle Flarie (IC 6
Dra�ve►• NO....O�Q� Q
WltatTarin9Distntli . . • ••••••
Card NO. ...�77s
...........
\UDROR J
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_ I � � 20— I "— :
Date (rrqnN.
� I/ We certify un�er ihe penalry of perjurC�that Ihe above arW foregoing infortnaUon is We and cortect arM that tha applinn[ is a resideni of Indiana and
I mntraG buyer ot the meri6oned property on date appliptlon is filed.
�' (oxne No me) , Date(nnvWi.daY•YmeA
X iID enta� / t � rartlstreet .�
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Penrn auNO�.d by OWy �ecueetl Power of Attomey rn by IC 61.7-72-0. Date (monN, UsY• Y��)
AdCress o( auCmr'¢ed person (numbe� aM sbeet, city, s!a(e. and LP mtle) .
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