HomeMy WebLinkAboutMortgage_Courtright^�� STATEMENT OF MORTGAGE OR
__,_ FOR DEDUCTION FROM ASSES:
State Fortn 43709 (R71 / FrW)
��' ,,,, aresaibed Oy Departmem m Laal covemmem Fuiar� 1 1 LU ��
INSTRUC7IONS: p,UG 1 �
To be l�ed in person or by mad with the Counry Auditor w Counry Recorder ol the munty where the gq�rty is located.
Filing Da[es: 7) Real Pioperty: Must file durirg the year /w which the deduclion is so+�c�/ µ(U �� �
2) Mobde / Manufactwed Fbmes rat assessed as Real Pmperty: Must fif�/dJAliryB�e twel �d�(fonfhs
6efo�e Malch 37 of each ysar the deducfkin rs sought. �N COUN�Y
See reverse side !or additbnal inshuGlons arM qualifications. G18S
MP�^���°!mntra�buyC-��esnice�ismre�side) _ . .
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A�etl vdue of rea� P�O�Y � N �
A1a`tli 1: a+rem ymr
I( ro. whai 5 his / tret t�acY share ollnterest?
tl �ame m rerntl's Sdferent Nan Nat of a00�4 ��te bebw
Name o1 rti�Mgagee or mntract seller
Addre39 of morVjagee or mntract
awner rn
sbte. aM
(numeer am saee{ rsy, sm�e. ena ur caae7
spvircau o.m v�ocehr io a�y omer
y i Indiana? r
❑ Yes l
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20 _ 20
File Mark
Form t�ed wilh:
� County Auditor
❑ Counry Remrdu
R¢mN numbpi Page numbri
oa vio 03
as of date of appOnUOn mtlehtedness unpaiC as d � or�eT+��ae awne(t
�Yes ❑ No
tt owried wBh someone other ihan spouse. Indimia Wth
COUNTYAUDR
p— � �—
Counry
IS iI1C P�Y 111 G�1: M�waM AsseSSCE
f�.9eal PmPertY ❑ Armuat�YAsse55ed
� Modle Hart�e (IC 6
Drawcr \O..�Q.�.�:.....
Card NO. .... 3':f:u�....
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20 _ � 20
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I I We certify under the penalry of perjury that the above and foregoing infortnalim is true and corteG aM that the applirant is a resideM of IrWiara and
owner I mntract buyer of Ne aforementioned property on date application is filed.
1naW21➢W�/3fWremeL�.� �� �(�.�Y.Ye�
by duty executed Powel W Attcmey w by IC G7.1-12-0.7
(rtpnlh, daY. 3��
Address o! aW�orrsEd G� (numberentl sbeet bN. sfate, entl [IV cotle) .
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