HomeMy WebLinkAboutMortgage_Hart (8)"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
,___ FOR DEDUCTION FROM ASSESSED VALUATION
.. � State Fortn 43709 (Rt 7/ 6-09)
S J Presai6ed by DeGa�M of Laml Govemment Frenca
INSTRUCTIONS: p�px�h
To 6e filed in person or by mail with fhe CounryAUditor or Counry Recorder of the county where fhe property is located. F�/-� �y a� Z � � 2
Fdirg Dates: 7) Real Pmperty: Must file dunng the year /or which the deduclion is sought. � County Auditor
2) Mobile / Manufactured Homes not assessed as Real Property: Must file dunng the hvelve (12J months C1-1�
6efore March 37 of each year the deduction is sought Lf' n�ReLOrde�
See ieverse side !or additional inslmcGons and qualifiwtions. _ , _ _ _ _ _ _ _ _ _ _ _ _
yisu � � . �y i cen i- yeyvipuon
� V
ed of real P�pc+�Y as of Rbnga9e / Contraa u
1, anrnl year Match 7, wrtent year
ihat a his! her exad share ot interesR
3 on recaE is dRerent ihan Nat af app6cant, mdirate bebw:
:n�
Address of rtwrtgagce or mntraq seller
Name af assignee or dher ovmer w
c�y, smt� ane
Adtlress of assig�e (number and speek �3: s1a1e, and Z/P cotle)
av.n property i^ any oNer
DeCUdion approveC in ihe artaunt of:
�
Sig�uMe of Camty A�d'rtur
20 � 20
whac munry?
COU
20
�a .
,._v^� 5�
adl�e
Yes L 1 No
� GroPenY in Cuestion: MnuaM Assessed
Rea� aroxrtv ❑ amua�y assessed
Moble Fiart�e (IC Gi.
NRwt Tadi ieM1y
llrawer NO....�t%I.�, —
........ No
4UDROR
Card \�O. ..���.�.� —
...........
�
�Y. YeaA
I/ We certrfy under the.penalry of peryury Nat the above and foregoing infortnalion is We and cortect arM Nat Ne appli�ant is a resident of Indiana arW
owner / contrad buyer of ihe aforementioned property on date applira0on is filed.
�reture (owneh hdl reme) _ Date (morYh, day, yea�
�ull resiEent aCAress o( applirant �(numberand street �ty. slate. and ZIP cotle)
-� v y� s. � ��� ��v2� a.e�r,�<
Person autironzed Oy Euty ezecureC Power o( AllomeY a �Y IC 61.1-12-0.7
slafe.
Date (month. tlaY•-Y��