HomeMy WebLinkAboutMortgage_Eagleson^�� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
__ , FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R71 / 6-09)
S � Presvibed by Department of Laal Govamment Finance
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INSTRUCTIONS:
To 6e fiied in person w by mail with the CounryAUditw or Counry Recorder of the oounry where the pro
Filing Dafes: 1) Real Pmperty: Must file durirg the year for which the detluction is sought
2) MobBe / ManulacNied Homes nof assessed as Real Property: Must fiie dunng the hve
betora Marcfi 37 0! each year the deduction is sought
See reverse sKle (or edditional instructbns and qualifications.
I Cbwa�-seercsOx'twuaniaverseAiCel i�i �
Keyraanber/
erart
rc name o� rema is amerw man mat a
rUme m imtgagee «oonuaa sen«
mntraa se0er
u�Cirate helrnr.
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rume Li'.�i}�i�� � �
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� Card !\'Os. ,��, �'� �yr�. pv
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Deduction app`wad 4i Oie anaunt oE
ZO _ 20 _ 20
� IIWec
o.mer I
20
oa-�oo • � a i
;mazor�
Coun Township Year
File Mark �
F
t
unty Auditor
(12) rtronMs � �nry Recordu
DEC 2 1
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as d I Is Ihe ePP��t tha sde
legal w epuilade ovmeY.+
❑ Yes ❑ No
rc aw�E w�h someo� oNm ma� spwue. 4W�xate with wbm
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�
Is the OroP�Y in QursGrn: MmiaOy A�,esseC
❑RealPropeAy ❑lvmuallyAsessed
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Yes ❑ No
Zp _ � 29
� L VCti-Y I �n� /�` %� A`11ALF/J`i�l-�� (�`^ �""''- l �.
Ne pen Iry ot perjury that Ihe above arW foregoing infomiation is We and mrtect arW that the applipnt is a resident of Indiana and
yer of the aforemeritioned rty oAdate application is 51ed.
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AEaress M autha2ed person (numbererM sbeeC ary. sb1e.