HomeMy WebLinkAboutMortgage_Emmons"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T i Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Fortn 43709 (R71 / 6-09)
� � Presaibe0 Oy DeDartment of Lnral Govemnrent Fu�arce
� File Mark
INSTRUCTIONS: AP
F d with:
To be filed in person w 6y mail wiN the County Auditor or Counry Recorder o/ the county where tAe property is located.
Fitirg Dates: 1) Real Property: Must file durrrg the year fof which Ihe deducLOn is wught. �����y p,�d{�p�
2J Mo6i7e / Manufacture0 Homes rat assessed as Real Properly Must file dunng the tweHe (12J months .(� =
6efwe March 37 0/ each year Ne deduction is swght. "m�tinry Recorder
See rev'/Ne side fw addifional insfructfons arM qualifications. G IBSON
ADO�n obi+vd mntract buYP!'iee resfnUiw�s m reverse si0e) �
ra�w,y o�sma � = O _
Ass�ssed raAc oF � ProPeM1Y as d Mwtga
�d&N 1. a+m�tl'/r.er N.B�
I
n �o. �t �s na i ne. exaa sn� or ��?
c � ��
�, Cantra¢ iMebtetlness unpaid as d MorL
wrtentymr date,
tt rwne m remrtl's SACernn than Nai d appuo^+-�ndkam Eelwr. �
Name of mort8a9ee or mntracl se9er
Addr� of rtarlga9ee or contraG seLes (nunt �•' -T �\C�. f1S
Name ot assigncre w oiher owner w hdder M ��rCL
PdCress of astignee (numOaraM SbeeL dp
Dces eppikant axn praperty in any olher
munry in indmna? � Yes
Deducom app�wad in ihe amount oF.
zo �_
sig�aw�e a counb a,aim.
of I Is Ne eppfirarit Ne sde
k9al a ewi'ade oa+�eYl
❑ Yes ❑ No
tl owned wim someane dher than sPO�+T�. ind�te wRh wlnm
��aS��r L�-,��5
�43,��,Ua
ao�D g�8
Is Me property in question: MnuaDy Assessed
� Real ProPenY ❑ ??���'1 �
Mas Na deducTion been requestetl m praputy
tw curtent yeaR ❑ Yes
❑ No
�_ �_
���„�.�Y��
I I We cerbfy under the penalry of perjury that Ne above and foregoing infortnalion is u ua ...._ recl and that Ne applipnt is a resident of IMiana aM
owner I mntracx buyer of the atorementioned property on date application is filed.
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stare,
of Aitomey ar by IC
aut�ortred pgsm (number ard sbeet �Y. stale. en0
Date (mmfi. deY. Yas�