HomeMy WebLinkAboutMortgage_Bates (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
��,_ ; FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fortn 43709 (R71 / 6-09) � �
�,�,� ` PrewiCed by �epartmeM af Loml Govemment Fu�ance
File Mark
�NSTRUCTIONS:
Fwm hled wiN:
To 6e (led in person w by mail with (he CountyAUditor or County Recorde� o/ Ne counry where Ihe pg��y "q Ivcat�/, �
Fil" Dates: 7 Real Pm Must file duri the ar for which the deduction is w ht. I`I ll V�+ 1 C ll
�^9 ) PQRY� ^9 Ye �9 unryAUditor
2) MobBe / Manufactured Homes nof assessed as Real Pmperly: Must h7e durirrg the hveMe (12) months
betore March 31 of eacA ysar fhe deduction is sought C. �. M,.�;�, ❑ Counry Rec«du
See reverse side !or additional instructions arM qualrficaGOns. V�� "
' trict 11 Key rwrtiber / kgal d tion � Remrtl rwmEer P
� �fs -� 7 -0 —�.O -ob� 914'-� � c �(�a--
rehie d property at Mw(pap e/ ConVaU trMebtedness unpaid az W Mortgage / Contra�Y mtleMednrss unpaiC a of Is ihe appl'xant ihe sde
arh � ae2nt Mamh �. airte�y yrar �� O� dafe of ePP�tirn legal O itade O R
I LD Yes No
ro, what a his / hu e�ct shara ol intrlrst? If owrre� wiM someone other �han spouse. indicate wuh Mom
il name m record s Qifferent Nan Nat of appGmnt, 6M'uate belmr.
Name of mwigagee u contract uller
Addres of rtnrtga9ce a mntraG se0er
awner or nolaer m mortgage
cdy, sfate. eM ZIP codej
eM street �; slafe, entl Z/P cotle)
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What Tabrg Distna?
Counry
zo
h IM property in Questim: Mnua�y Assesud
❑ Real Roperly ❑ ArmuallyPssessed
Mobile Fiome fIC 61.
Mas Na dedutlion Eeen requested on pioperty
fw curtent yea(.� � �
�
Da1e (rtmN. day 3'��
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I/ We certity under the penalry df perjury N above and foregoing infortnatlon is W e anC correct arM tha[ Ne applirant is a resident of IMiara arW
owner / mntract buyer ot ihe aforemention rty on date applira4an is filed.
7re➢ue (owneh (u0 name) Date (rtwiCi. daY. Wan
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Jlresi0ent da p t(numberanOSheaf,dly,s7ate,aMZlPCOde)
, h s s 't � � S
xson aWairzed by tluy exewte0 Power o( Attomey w by IC 61.1-12-0.7 0� (rr�omn. ear. sE�
Address of auMOr¢ed persw� ( num0era� sLee( py. state.