HomeMy WebLinkAboutMortgage_Monroe (3)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
:�__..
: FOR DEDUCTION FROM ASSESSED VALUATION
- • State Fwm 43709 (R71 /6-W)
,,,,� ` PresaiEed by Departmem of Lacal GovemmeM Fu�ance
�STRUCTIONS: ��
0 6e filed in person or by mail with the CountyAUditor or Counry Recorder o� the aounry where the property is I
Fting Dates: 1) Real Property: Must �de during the yearlor which the deduction is soughf.
2J Mob�7e / ManufacNred Homes rrot assessed as Real Pmperty: Must file during the twelve (72) m��i� r
betore Marcfr 37 of each year Ne deduclion is sought. O
See reverse side for addrtional instructions and qualficateons. C ��
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INa�tll 1, finvil yrdr
If rw. whal is his! ha e�t share 0( interest?
If n2me on remrE's tlMerent Nan that of aOW�x ��� �low.
r�ame ut mongagee «cono-aa se��er
adaress w mmqa9ee «cano-aa seuu
Name of assignee or oNer oxner m ho4
Aildress of asvgnee (number arM sIIae.
Ooes appli`ant wm property in any oNE
munry in Ind'aria?
❑ Yes
Counry Auditor
County Recorder
° a o a-�oo •�� 8-b H�° i°� _ Y���g
ett intlebte0ness unpaid as W Mortgaqe / CantrarY iMebtetlnrss unpaitl as d Is IAe appfifant the sole
� I,� �•� date of aPPlication legal nuita�de owrrt(t
sfate,
= �� l �
Dra�ver NO ...................
CACd NO. ...°���5.......
� �a, �aa.�
zo , �— , �— , 20— , �
Is ihe properry in Question: MnuaM Assesse0
❑ Rea� a�openy ❑ am�,aay a�ssed
5 U�is deduUion Deen requested m pmpeity
�� Year ❑ Yes ❑ No
� � �
I/ We certify under the penalry of perjury Nat Ne above arM foregoing information is We end correct arid that the applicant is a resideni of InCiare aM
owner I contract byye �of ihe atofementioned property on date appliration is filetl.
I ^i� , ^a e�fj Date (nwrth, daY.lsaA
Pason authorized Oy
FMr o( Atim�ey w by IC 61.742-0.7
P4tlre55 of au�hor'¢Ed person (numbe� aiM SLee( ciry, sbla,
Date (rtarrth. Eal: Y��