HomeMy WebLinkAboutMortgage_Gerling'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
__ s FOR DEDUCTION FROM ASSESSED VALUATION
n Shate Fwm 43709 (R71 / 6-09)
,,' f PresoibeE by Departrtient of Local Govemment Fuance .
F'
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or Counry Recorder o/ the county where the property is located. q�p q
v L� (�(�Q
Fil"mg Dates: 1) Real Pmperty: Must file durirg the year (or wbich the deducfion is soughL � CounCyAGditw
2) MobBe / Manufactured Homes rat assessed as Real Pmperty M�st file dunng Ihe hveHe �72J months �
6etae March 37 o/each yearthe deduction is soughL Coun Remrder
s...,
See reverse side for addiUOnal inshucGons arM qual/fications. Q'
nppfcary�(rymerormnvaabyer lesuicegqsynrerersesde) AUDITOR
u�� iuco-i7—i n- �.
f real paperty as d Mortgage / Cantrac[ ir
year Mart�h 1, arte�rt year
n no. wnat rs tus r trer exad snare ot intemsR
I1 name m temrC a Eifterent Nan Nat of applkant indirate bebw
N2rt�C Of (IbrtJ29CC b W�1f2U SWU
Addres W rtnrtgagre w contrad se0er
Name a1 assi9�ee w othn avmer or hd
Does appHnnt ovm property in any oNer
counryinlndiana? ❑ Y25
DeducGOn appraved 41 �he amWn1
r�; sbte,
rt�ortgage
state, and ZIP mde)
If yes. wha! muntyt
No
zo _ zo _ x
Sigretlne d Caimty MiEitor
I/ We certiy u�Wer the penalry of perjury Mat the .
owner! contraG buyer of the aforementiwied pro[
.Sigfature(owxhhNname) v"""V � \
Full revtlent aEdress of applibnl (numberand sbeef, tlty, s
� � � �'oU -T�e-w=rr-
Person auUqraed Gy duty executetl Power of Attomey a Oy
Pddren of aWVrzed persan (^umberaM sbeet ary. sbte.
It awned .
yp��i
i
D1'8\VCI" �D...�w '/••.••.
c���� �o. ....�.89/.0.......
�53,���
61.142-0]
as o! Is Ne appfcant the sale
legal w equitade amef!
❑ Yes ❑ No
n wrwm
30on: nrinuaM �.ssessed
� Armually AssesSed
I \1��J�y/��
� � V `
I n/
W
d on property
, ❑ No
20 _ 20
Date (,r�W. day Y��
: Ne applirant is a resident of IfWWiana and
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