HomeMy WebLinkAboutMortgage_Matsel (3)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou owns ( Y r
__ : FOR DEDUCTION FROM ASSESSED VALUATION ' -
~ Stata Fwm 43709 (R77 / 609)
� 1 PrPSaibetl M Departmcrit d L.oral Govemmerit Frence
OCFeeQafs 2009
wsrRUCnoNS:
Form t�ed with:
To be filed in person or by mail wiN the Co�ntyAud'nor or Counry Recorder of fhe counry where the property is located. �y
Filing Dates: 7) Real Property: Must fJe durirg the year for which fhe deduction is sought. IFd-: (bd'rifv.'yuiditnr
2) Mo6�7e /Manulactured Homes rrot assessed as Real Property Must file dunng the hveHe (72J months '"'1 t/
be(ore March 37 oleach year the deduction is srought GIBS N�NE9�7lYJ��C�
See reverse side (w additrona/ inshucGons and qualifrcatrons.
nt (ownerwcantraU buyer - see restncbons m 2verse sdej
Ta�M1g Distri Key number / legal desaiption Remrtl number Page numEu
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As�sed rdlue of � yoperty as W Mortgage / Contraa iMebtednass unpaid az o( Mortgage I Conraa inEebtednass unpaid as of Is ihe ap{tlkant Ne sole
Marrh i. amnt yrar Merch 1, airt�e7m year date of appGmtion kgal w eWitab�e owneR
l O O D ❑ Yes ❑ No
Ii ra, what a h'a / her e�ct share or interest? It owned vriN someone ocher ihan spou.u, iMi�[a wiih vRqm
�f name m remrtl's 6ttumt Nan that W a7P�^L'oiE"uzte bebw Is fie PbDertY in Vurstion: MnuaDY Assessed
❑ Re� a�oaenv ❑ /vmuan,iassessea
GT'�1TI
assignee or Whu owner or hdder W mortgage
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Adtlress ot assignee (num0er antl sheet ab: slate, aM LP code)
Dces appli�ant wm property in any aNer
munty in Ind'ena? r-� . _
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Counry
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day, yea�
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I I We certify urWer �he penalty of perjury that Ihe above and foregoing infwmation is We and cortect arW ihal the applicant is a resident of indiana arM
owner I contract buyer of the atorementioned property on date appliratlon is filed.
I^aQ�re (owneh hAreme) .. . Date (monM, daY. Y��
ciry, state, and
dUnmsd�Wi' e:ewied aaweYw nvorr�er or ev iC 6i.t-iz-0.t I oate (monm, daY.
of a W�or¢ed person (numba� and snee; cRy: state, aM LP code) .