HomeMy WebLinkAboutMortgage_Norris"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ a FOR DEDUCTION FROM ASSESSED VALUATION
' ..• Slate Fortn 43709 (R11/6-09) � g� �
� 1 PrewiOed by DePM�rit af Local Govemment Fuiance �
w�.
File Mark
�1STRUCT70NS:
Fwm hled wiN:
(0 6e fited in person w by mail witA Ihe County Auditor or County RecoNer o/ the�Qyq�; e2 !he property is bcated.
Filirg Dates: 7) Real Property: Must file dumg the yrear for which Ihe deduction is�Y61Ajh "ZQ �� Counry Auditor
2) Mo6ile / Manufactured Homes rwf assessed as Real Property: Must hle dunng fhe fweAre (12) months
6efo2 March 37 0/ each year the deduction is soughL C. �, ry�,-�2--- ❑ Cw+nty Recordu
See reverse side tor additional instructions and qualifications. \� \
A55essed ra4ie oFreal papttty as d
� 1. amerrt ym
tt m, what fs h"s I her exact share of ii
Itl�2mC On fKWd'S tliRefa�t N2n �h2�
Name W rtnrt8a9� or cmtracl seDer
Atldress of mat9a9ce w cantrad u0
Name of assignee or dher owner or Y
Adtlress ot atsignee (number aM sm
Key wmce�
ol appliran4 �dinte bebw
appliraM ovm pmperty in any oNer
y in Ind'ana? ❑ Yes
•t�-e�
zo � zo
C��
�umber antl stree4 �Y, SBtC, aM ZIP croee
3r M nqrtgage
ciry, slate, aM ZIP cotle)
If yes. what munty?
❑ No
coui
� 20
I/ We certify under Ne penalry of pe�ury�Mat Ne
� owner I contract buyer of �he aforemenfioneG pro
am street
��• ��I
�
Is Ihe applront Me sde
legal n equitatle aaneR
❑ Yes ❑ No
wiM someone oNer ihan spouse. ildirate with whom
Is the property in Question: Mnualty Assessed
❑ Real RoPe�tY ❑ Nmually Pssessed
-�-�..•:..,, heen re9uesled m 7ropenY
5 ❑ I
Dra�ti�cr \'O:. �� �;� ....
...
Cal'd NO. ... y� � d .
.
�ys,�� �. ...
� � w� /
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(oregning in(wrtiation is true and carect arW Uat Ne apDlinnt is a resident o( IMiana and
!e applicatlon is filed.
Pason authoi'ved Gy duy exearted PoMer W Ntnney or by IC 61.1-1�-0.7 I Date (mwrth. OaY• Y��
Pddress of aW�a¢ed G�� (noniberend 58eeL cp�t sfafi. an0 LP code) .