HomeMy WebLinkAboutMortgage_Dodd-T""* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Couni
; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fwm 43709 (R71 / 6-09)
S,.,. 1 PresaiGed by Departrtiem of Loml Govemment Frence �
INSTRUCT70NS:
To be filed in person or by mail with fhe CounryAUditw or Counry Recorder o7 the counry whe2 Ihe property is bcated.
Filing Da[es: 7) Real Pmperfy: Musf Tle dunng Ute }rear Por which the deduction is sought.
2J Mo6de / Manulactumd Homes not assessed as Real PropeRy: Mus! file dunng fhe twelve (12) months
be(ore March 31 of each year the deduction is sought.
See reverse side /or addilional insWC(lons and qualil'ications.
Assessed �ahie oF inal O�P�1' m N
IYa�N 1. ar�� ye.ar
rc m, �c �s na i ne� �a y,are o� �rea�ca
� I Contra(x indebte0ness unpaid as of I Mongage I Convar2
airtent yeer data a( appGtation �
tt name m recad is Ciiluent than that of appGran4 h�dinte beloh'
Nama ot �nutgagee or convad uUer
«cmaaa
owner
ciry, state. aM LP code)
Pild�ess of assgnee (number eM sveef, ltiy, slate, antl LP cotle)
Dces e�ifant awn property in any oNer I I( yes.
oouMy m IMaru?
❑ Yes ❑ No
2� _
���
I/We
�B �
�1Fu �
..�__'
�m ��
unpaid as d
Y� u r,o
Is the proputy in puestion: Mnually Assesud
❑ Real ProPenY ❑ ���Y �
M1bb7e Fiortie IIC G7.
-- .I tlas Ns deduction Oeen reGUrsietl m G�+�Y
COUNTYAUDITOR D1•ati}�er i\'O. °2�,9
approved in Ihe amounl ot
. .........
zo_ zo zo Card \io� .'.. 335�
..................
��,ry„�,�� ��ry 05, -r.�Op. o0
certify under Ne penalry of perjury that ihe above and foregoing infortnatlon is W e and correc[ and that the appiiqnt is a resident of IMiana arw
/ mntraG bu—ye�r of l�i�e aforementiaied property on date applicalion is filed.
�wrwl . I 1 / Ddte (rtrYlfi. daY. Wa/%1
execute0 Power of Anamey w by
Pddress of authorrseO pe+son (number arM slree4 �+0: sbre,
Date (monfh. daY. Y��I