HomeMy WebLinkAboutMortgage_Coy"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ : FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 43709 (R71 / 6-09)
S I p���� pY pe��� OI Loral GovernmeM Fu�ance
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INSTRUCTIONS:
To be filed in person a by mail with the CountyAuditof or Counry Recorder o! the county where the property is located.
FiRrg Dates: 1) Real Property: Must file dun�g the year fir which the deducLOn is sought.
2) Mobde / Manufecfured Hortres rat assessed as Real Property: Must file dunng the nvelve (12) monNs
before March 31 of each year the deduction is srougAt.
See reverse side !or addilionaf instrucUons and quali�cations.
t(awner or mnvaft buyer - s resbicnons m reverse side) - � J
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Oistricl
rw� wnat rs ns llrer n.�e+
urh6es / legal Cesaiption
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It �urtie on �ecoN s dMerent than Nat of aDp6rartt. mtlkata bebw
Name Ot mwtgagee or cuntrad seller �"
Atldress of rtwrc,7agee w mntrad se0er (nwn6er aM sbae;
Name ot ass"gnee w other ownet or holder of mongage
timnt avm property in a�ry otha
��m�z
❑ Yes ❑ No
Deduction app�vued m ihe amount of:
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If yes, what munt/T
zo_ i � i �
SignatlaeNCrnmryAUditor /� /`
� Y � �/L� ��
I/ We certify u er the penatty of
owner I contract buyer of the afon
Counry Auditnr
_oOo�. Vo2OO—O eZ.S O9 �{�l—�
etlnass unpaid as of Mortgage / Contraa'uWebteOness unpxitl as d Is Ihe apprvnt ihe sak
date of appliption �e9a1 or eQuitade ownM
❑ Yes ❑ No
If awned with samearre other than spouse. iMirate wiTh whom
zo
Is IM p�operty in Question: MnuaOy Assessed
� Real Property ❑ MnUally Assessed
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W�atTaz _' ' _ �_'......MO�p�y
Dra�veril'O...r�QQq. —
auoRC Card 1 yl � .... -
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Caunry Date (monN, day, yee�� ' '
Ihat Ne above and foregoing infwmatlon is W e and mrrect arid that Ne apD���nt is a 2sident of Indiana and
ned property on date application is filed.
Date (month. daY. Yea�
FWI resitlent address of appfxaA()number M street, dty, state,
�a3-� S u5 l�,sti �,-, '
Person autho�@ed Oy duy exeateC Power oflutomey Cy IC I
of auUar'vcd person (number aM sfree4 �: sbte. aM LP code)
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