HomeMy WebLinkAboutMortgage_Marvel^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ . FOR DEDUCTION FROM ASSESSED VALUATION
S�te Fwm 43709 (R71 ! 6-09)
�' �.r Presvibed M �ePartmeM of Lacal Govemment Firence
INSTRUCTiONS: @pa
To 6e filed in person w by mail with the CouniyAud'ROr or Counry Recorder o/ the munry where the pioperty is lo�� 2 F I U�:
Fit'vg Dates: 1) Real Pmperty: Must file dunm� the year (or which the deduclion is wught. � County Auditor
2J Mo6ile / Manufactured Homes rrot assessed as Real Property: Must fi/e during the Iwefve (72) mon[hs ❑
6eforn March 31 of each year the deduction is sought. � Caunty Recorder
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See /everse side for additional instrucGOns and qual'rfications. ��' �
�pfi�ant(ownerwcontraCbuyer-see mreverseside� � \ jaIB50N C� �I
b�g Disbicl . Key number / legal dnsaiption � / Rem�d numbPr Page
. 9-ao-�oo-000.lC�o-o�-S lo l�� �
M.essetl vahie d� poperty a of MoRgage / Contract inde6tetlnPSS unpeid as of Mortgage! Contract'videbtetlrress unpaid as of Is ihe epplkant tlre sde
Marh 1. amnt yPar Mard� 1. wrte�rt year tlate of aPP��� legal w epuitade ovme/!
� ODU ❑Yes ❑No
ii M. WFI3� 6�15 � �12f E%dLI5�l2f8 Oi Ifl}EfESi� �( ONTBd VAI�I 50I11EME O�IEf tl12fI 5P01152. I�IQIE Midl W�HIfl1
1f name on'em�i e 6lterrn� Nan that of aPP�rt�• ��� ��'^' Is Me property in puestion: Mnua%ASSessed
❑ Real ProPeKY ❑ %���Y� . . .
ar mntrae
I�L'i:.•.'"-.n'�
Name af a4gnee w W�n1
(number and sbee4 cdy, state. arN LP cade)
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Dra�`,�, �O•• �����
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C�r�]\�• .... •
��IlWecertifyuru
owner I mntrad
Person
20 20
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�enalry oi perjury that th abc
�f the aforementioned p pert
ant (number andS�L= ; state
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wted Power af AttorneY a bY IC
MEress of aNhor¢ed person (number antl sbae; cdy, state.
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What Tapng Oistricl?
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dedumm Ecen re9ues1e0 m P��Y
� � ❑ Yes ❑ No
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trate (monN. daY• Y��
e arW foregoing infwmation is true and correct and Mat the applinnt is a resideM of IrMiana a�
on date appl'�calion is filed.
Date (rtnnN, day, yaa�
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