HomeMy WebLinkAboutMortgage_Reinhart^'�* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
= FOR DEDUCTION FROM ASSESSED VALUATION
'�— � • State Fortn 43709 (R71 / 6-09)
��' ,w I Pr¢scibed by DepaNreM of Local Covemmenl Fu�ance
°�'NSraucnoNS:
To be lled in person w by mail with the CounryAuditor or Counry Recorder of the counry where the pmperty is located.
� Fd"rtg Dates: 7J Real Pmpeiry: Must file during the year /or which the deduclion is sought.
2) Mo6de / ManuFactured Homes rpt assessed as Real PropeAy: Must fi!e dunng the fwelve (12J months
be(ole March 37 of each year the deduction is srought.
See reverse side /or addifional instrucGons and qua/ficafions.
As�tseC vapredmal P�W��Yasof
Mamh 1 � aa�ent Year
If rw. whal is his / her ezaG share o
u name on rewrd is cmerem man u
m�aaa seuer
of assignee or
number iAegal desuiption
.� � ��
ge/COnVaCin
Ma 1, artent yeer
C.
as� LS Ne appl'imnl the sWe
legal a eWitade oxme(!
� Yes ❑ No
' If owned wiM samea�e other tlan spa�se. Nd�te with wtw�n '
uMinte belmr. C�e Wope+ry m Vuestion: MnuaOylvssessetl
�r�l PmPertY ❑'MnualyAssessed
r Modle Home (IC 6
�� �: �=e,
mortgage
AdEfess oi as9gnce (num6er antl stree4 �1y. state, arq ur ooae)
po¢s applipM own poperty in any oNU If yes. what munir
counry in Indiana?
� ❑ Yes �Jo
approved'o� Ihe amoum of:
20 _ � 20 _
� ��"1; ���� �
�1 "
�a-7ga.
AUDROR
20 � 20 � 20 _ I 20 _ I 20
��4rte N Counb AuditOr I Counry I Date (rtanN. EaY. Y�n
I/ We certify under the penalry of pe�ury that the above and foregoing infortnalion is W e and correct arW Nat the applicant is a resident of InEfana arM
amer I conVad Duyer of ihe atoremeniioned property on date application is filed.
]reture f.9�+�/�mdl_ � . /I _ . i Date(rtwYh.daY.Y��)
��`� � S .
�, aw,o�a ey ewy
Mdress ot aWmrtred pb:
51ate, antl [IY cd
IC 61.1-12-07
(num6ra aM sbeeL dry, s�e,
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