HomeMy WebLinkAboutMortgage_Money'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
� FOR DEDUCTION FROM ASSESSED VALUATION g �
� � �' � �• State Fortn 43709 (R11 /609) � � �
�' f Presaibed by �epartment of Lual Govemment Fnance
File Mark
�srRUCnoNS: q
To be filed in rson w by mail wifh [he Coun Auditor orCoun Recorder o/ the coun F� �� ��
PQ N N 1�7��aJAe p is locafed.
FiI'mg Dates: i) Real Property Must file during the year for which fhe deduclion is wught. �e1�7 � Counry Auditor
2J Mobife /Manufactu�ed Homes not assessed as Real Property Must filadmir�gV1Y�� " V2J months
before Mamh 31 of each year the deductan is soughf. ❑ County Recorder
Seereversesicieloraddi6onBlinstructbnsarMquali�rations. _._�,,,,���iNTYAUDITOR
raAns ois a Ker � r
AstesseG �rd�re dreal P�P�Y %s d �
Mard� 7, amatt 7� 1
If ro, whal's ha I Mr enad share ot interest?
If rame on 2catd is ddferent Nan Ihat at aPp&ant,
Name of mortgagee ar conuari seller
��3� _o7/-oaS --- �l�- � a°�`
unpaid as W Mongage / ContrarY cde6teE�ress �mpaid as of Is ihe eP�� Me sole
Oate of appGCation � a ew��e �T�
�% ❑ Yes ❑ No
It avmed vrith someorre oNer ihan spouse, fMicate with wtwm
h tl�e P�GertY in Ouestion: Mnua�Y Assesud
❑ Real PmPertv ❑ M^ualh/ Pssessed .
Add2s of rtartqagce ar conbar� se0er (n �xr and streel, aTy, stafe. eM LP code)
p�y� a} ��¢¢ pr otl�e1 oxmer or hdder of mortgage
P.dCress o1 assignee (mm�ber aW street �Y, s1are. entl Z/P code)
n+w¢ aodicant am P!�P�Y in any oNer _-- If yes. what munt�/1
r1
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'� ��5.9�0. °—° W�
I/ We certify urWer the penalry'oi perjury that �ie above anA fc
owner / contracl buyer of ihe afwementioned property on date
�
Power of Attorney
Atldress W aWror'¢ed persm (number aM stree4 �ry. state, and ZIP code)
20
YNat Tad(g Disvict7 I Has Nis deduCion Eeen reQUesicW m propeM1y
ta artem yeaR � Yes ❑ No
aUDROR
20 20 2q _
ca,nry oate (morvn. dar, yea�
�alion's true and cortect and Nat the appli�ant is'a resident of Intliana ard
is filed.
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(monN, day, yaa�
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