HomeMy WebLinkAboutMortgage_Conner^'�+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
=,_—.
� FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Fortn 43709 (R71 / 6-09)
S Presr+ibed 6y DepartmeM of Lncal Govemrtrent Fnance
"' File Mark
�STRUCTIONS:
JUL , ,�:
To 6e �led in person w by mail with fhe CountyAuditor or Counry Recorder o/ the counry where the property is located.
Filirg Dates: 7) Real Property: Must file during the year /or which the deduction is sought C. �. ry Counry Auditnr
2) Mobde / ManufacNred Homes not assessed as Real Property: Must file dunng the Iwelve (12) months (� unry Recorder
be(ore March 37 0( each year Ne deduction is sought.
See reverse side for addi6onal inshucLnns arM qualfications. G I BSON C O'�'
Aod'marM�{owrier or oontract buyer - see rgsty�cbqps on 2re{ee�sida)
Tavng, isbia KeY ��+/ �I desaip' Remrd n Pa9e wmoa
F a�-r �-i 9-�0! o00 65� �� � / �a �
A�sed vdlue af real PoP�Y as d Mortga9e / Conbaa iMehtetlnass u Vaid as ot Morigage I ContraG'vWeMeAnrss isGaid a of Is Ne aPP��t the sde
Martl� 1, ar2nt ymr �.1azU 1. wrrem � Eate of appGaiion kgal or epWlade ame(1
a ❑ Y� ❑ No
11 no, xTal a his / her esa�l shere of interest? If owneG wiN sameane aher ttun spouse, indicate wtth whom
If rwr�e on reowd is dMuenl Nan that o( aDP���, uMifate bebw. Is the P�oVertY in Question: MnuallY Assessed
�Real ProPenY ❑ �^�!�Y �� . . .
Name ol rtnrtgagee or mnUad se�er
Address ot mort�agee w cmtract seAer (number end sb
Name oT assignea w oNer awner or hdder of mort9a9e
PdEress of assgnee (num6er and streeL my. state. and
Doe� aPd�nt wm property in any oNer
couHy Indau? � ,PS ❑ No
Detluctim apyove0 in tlre amoum oF.
20 _ 20 _
Signature of Camry AuEimr
cdy. sfate. aM ZIP code)
a2��4o� � �NN�r`
If yrs. whal munp? VJh
COUNTY AL'
20 20 20
iJ -3�a �
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Date (nonlh. daY. Y��
� v��xro
❑ No
20
I I We certify under Ne penalry of perjury Nat Ne above ard foregoing infortnaGon is We and mrteU and tha[ the applirant is a resident of Indiana aM
owner / contracl buyer W ihe afo�mentianed property an date application is filed.
�.,�e� ,,,.,.,e.<ea a Data (month. daY. Y'�a�
FWI rnsident aEtl�¢s ot ap�rant (numeer antl sneet, ary, uat
\So�L F &�s S ,��
Person autt�d by dWy exearteE Pouer of Anomey m by IC 61.
of authwaed persan (num6cr arM sUeet, tdy, state, and ZIP cade)
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