HomeMy WebLinkAboutMortgage_Church (2)'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
_. FOR DEDUCTION FROM ASSESSED VALUATION
• State Fmn 43709 (Rt1 / 6-09)
� � Presmbetl M DepaNnerq W LoWI GovemmeN Fuianro
� File Mark
INSTRUCTIONS: ' : �
To 6e filed in person or by mail with fhe CountyAUditor or Counry Reoorder of the county whele the property is located.
FiNrg Dates: 1) Real Property: Must file durirrc� the year (or which Ne deduction is soughL � Counry Auditnr
2) Mobr7e / Manuladured Homes rat assessed as Real Property Must fiie dunng tAe tweNe (72) months �aa���///
betore March 31 0! each year Ne deduclion is s�wghG �,a�,Recorder
//
Seereversasideforadditionalinshuctlonsandqualificafions. ..,ocnu cnIIn1TV AUDITOR
� �-� �. �.u�w �
Assessed rahc d real qoperty at of Moryag e/ Contract u
Mertii 1, anent year Mard� 1, artent year
H m. what b h's / her ereC shara of interesl?
rartie m remd is diReren� Nan that W appOfan4 �7�� Debr'
Nart�e M morttAaagee or mntraG se9er
mo� s
nedrass a rt�gagrE or mno-aa seuer (
Name ot assignee m oNn avmer w hoN
Adtlmss o/ assi�ea (numbal an0 sneet
Oces epplitar�[ oxn praprlty u+ eny ot�er
munry in Indiana7
❑ Yes
Daduction appwed'm Ihe amouN of:
20_ 20_
s��a,� a ca,�n a,eav
/�J/,,4�.�- Q��-�
nemDer and strce; cdy, sbfe. ard LP cade
er d mortgage
rdy, s�fe, antl LP oode)
�f Y�. wha� mu�
❑ No
COU
2(1 2�
� o - Da (� b
az of Matgage / Can� mCebtedness un0aitl as of Is t
date af apPGfation � _ _ _ kg
If owneE with sar�wne other ihan
Yes I J No
�e poperty in Oues�m: MnuellY PssesseC
Real Property ❑ nm,ualy wssessed
,�tT� �O�° .
�l�a���r �0......... .. .
4UDROR � � +, ••••••••
C3T(� 1O• ..........
� � � � i, �15- �
i
camy , � �,�m, aar.,een
�
I I We certify u�er the penalty ot perjury ihat ihe above and foregoing infortnalion is true and cortect ar�d that Ne appiicant is a resident of IfMiana atM
owner I contract buyer of Ne ataementioned property on date apPlication is filed.
�m�e lo�en r„a �� oa� ��m. dar, ree�
_,
FulRrsident
ez¢fyt¢E Ppwrl af AttorneY a M IC 61.7-12-0.7
of aWmr'ved persa� (number ar�d sbeet �: s+ate.
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