HomeMy WebLinkAboutMortgage_Pinard"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun wns r
_. = FOR DEDUCTION FROM ASSESSED VALUATION
� State Fartn 43709 (R17 / 6O9)
�,w, � Presaibed by Depar[meM of Laal Govemrtrent Fnance
f�C
�srRUCnoNS:
To 6e filed in person or by mail with fhe CountyAudito� or Counry Recorder of the county where fhe property is located. °�'
Fifing Dates: 1 j Real Properry: Must file dunng fhe yrear lor which the deductan is sought. � n ditor
2) Mo6�7e /Manufactured Hwnes irot assessed as Real Property Must Tle dunng the fweNe (12J rtantF� � BS N C�N���V�p�
6efore March 37 of each year the deducGOn is sought.
See reverse side 7or additbnal instructions and qualifications.
AoNira(v'fDwrerorcontrartbuver-see rnre siiel _
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Marfh t, aman yPar
It m. what is ha l hu exaa sha�e of interast?
If name on recad
��y-o �� 3�o-ado
ge/ Cantraa mGehtedness unpaid as of
Ma 1. artent year
mufpagee ar mntraU se9er , ^ /� �
7 i�' / �1/
of mor[gagrP or mntracl seDer (num6er arM strae; ciry, sfate, and ZIP code)
Nyne of a4i�ae ot oMer owner ar hdder of mortgage
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es.
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ra���er \0....: ...
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Card NO. . ��•�••.. �.�....
Recafd numDU P e number
-vas a��a ��
ContrafY uMeMedness impaid as d Is Ne apprxant Na sde
�/Y�'1 kgal a W��tade o�nrel+
( XIL J n Yes ❑ No
If awned with someona other tlan
• %-3-�0
W�a� Tadng District7
COUNTYAUDROR
20 _
Counry
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pope`ty in QuesCOn: MnuaDy ASSesseO
eal RoPertY ❑ Mnually ASSe55ed
0.lobile Fbrt�e (IC 61.
Has Na tletlutlian Eeen reQuested m prapuly
far weren� Y�n � Yes ❑
zo I zo
I I We certify under ihe penalty of perjury that the above and foregoing infortnation is We and corteU arid thai the applirant is a resident of IrWiana aM
owner I wntract buyer of ihe afwementiqned property on date appliradon is fiied.
� Sipnawre
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Pe�wn aWp�¢ed by EWy ezecuted
Pdtlress ot authoraed person (number aM sbee; dry, state, anC ZIP ootle)
Dace (rtonfi, daY. Y��)
n�° (rtronlA. d2Y. Y�A