HomeMy WebLinkAboutMortgage_Dykery� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ + FOR DEDUCTION FROM ASSESSED VALU�� ��
State Fortn 43709 (R71 / 609) '
•� �«. j P�esvibad by DePartmem at Lual GovemmeN�i�r�c�y \ �
INSTRUCTIONS: J ( � File Mark
To be fiied in person a by mail with the CountyAudifor or Counry RecoNe� o/ tAe county Wh�� tlle �M'�,rty is located. F� m� �:
Fi/irg Dates: 1) Real PropeRy: M�st file during the year Por which fhe tleduction is soughL ,�pnty Auditor
2) Mobde /ManuFaclured Homes rrof assessed as Real PropeRy Musf fded�nSlQd�vdsg /12) rtwnths
befae March 37 oI each year the deduclion is saght. v\� ❑ County Recorder
Seereversesideforaddifionalinsfructionsandqual�cations. 4 ONCOUNTYAUDITOR
Appfxant ( oonfrad buyer- see resbictiqn��rQser3e sidej , � � /�
x rnal popeny as m
Y�
11 nartie m rem`d
Name ot rtnrtgagce w contrxt seUer
Pddress W mortgagce m m�tract se�er
number / legal d�saipUan
a�-�s-i3 -� -oc�o. �� - c
Mortgage / Contraa'udebted�ss unpaid az of Mortgage / Conva
March t. ar2n1 y�gr� �'_ date of aPP��^
n oNer vrmu u MWUW mMgage
bela�r
rdy, sbte,
AEd2ss of asvgnee (rwmOer ftea{ �lb, and ZIP cotle)
_�� _ �Ji?�. .
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DC�I\'G' �'��..��.........
Cal'Cj �'�. ....V 1.��.......
Sigrenne
If awnad with mmeone dhar �han spouse. ind'xate wtth whom
COUNTYAUDROR
20_ � 20_
Counry
a�oaenv ❑
ro� a�n y�n
I N_
Yes L� No
MnuaOyAssrssed
rea�ra�a o� v�a�r
Date (month. daY• Y��
�
I I We certify under Ue perlalry of perjur�fhat the ahove arW �iregning infomiation is We and correct and fhat Ne applinn[ is a resident oi Indiana arW
owner I contracl buyer of the afinementioned property on daYe appiication is fiietl.
resitlent atltlrrss ol appGrant (num0er�b�tl sLee4 dry, stata, and LP cotle)
�Y. Yaar)
Adtlress oi authot"vEd person (number aM 5treet, city, stdffi, a/M LPCOde)