HomeMy WebLinkAboutMortgage_Heldt (3)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION (�
• State Fwm 43709 (R71 / 609) �J�\
S.u. � Presaibed bY ��ril W Lod Govemrtient Fuance �
q/ File Mark
INSTRUCTIONS: � �
To be fiied in person w by mail with the CountyAUditor or Counry Recorder o( the county where the property is located. Form med wim:
F�7ing Dates: i) Real Properry.' Musf file durirg the year (or whirh fhe deduction is sought. � Cqunty Auditor
2) Mo6de / Manulactured Nomes rat assessed as Real Property Must fiie dunrg the tweNe (12) mon�frs
be(ae Ma/ch 37 of each year the deduction is sought. ❑ Counry Remrdu
See reverse �e lor additional instrucj'pns and qualifrcations. --
ab- l -� � - o - �: �
Assessed rWUe o( 2al propaty az d
�M� i. arrefrt year
Ii ro. what a his ! hps ezact share o! ininl�t?
If riMie on remrd "s 6Rere
Name oi mongagee or cw.
Addtess ot �rotgagee w �
Name o1 assignee w othe
AdCress ot assignee (nur.
Oces applirant wm pmP
munry in IMana?
De�ucbm approued in tl
20
Nan Nat of aD�4 ��1e Ge�ov.c
inEe6teCness unpaid a5 of Mortgage / ComraC iMebteAness unpaid as af h Ihe aPW�t the sale
date ot appfmation legal w equRaNe oxne(.+
I46• ❑Y� ❑No
�
���
1
VL
�
�
�[�
D
�
G
�
'r
-�
�9
1/ We certify urWef ihe penalry of perjury tna[ me ew.� a�.. ._. _�_...,, �-�
owner I mntract buyer of the aforemerrtioned property on date applidtlon is filed.
lrature (olmeYS hAname) . �
P�/�h auNOirzed Ey Ouy esecuted Power o(Anorney m by
Pddress of a Wwr'¢ed person (number arM sfreet ciry. state
ZlPCOde)
LP mde)
`�
G
C
�
Is iM property in purstion: MnuaDy ASSesseC
❑ Real Property ❑ Annually Assessed
MoWle Fiome fIC 6
n reQUesteE m p�opelty
20
a resident oi IrWiana aM
Data (monM, day, yue�
Date (monfh. EaY• Y��