HomeMy WebLinkAboutMortgage_Elliott (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE� Y un ip Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
• S1ate Fortn 63709 (R71 / 6-09)
\ / Presaibed Cy DeP��� of lnd GovemmeN Fviance �
� f File Mark
INSTRUCTIONS:
To 6e filed in person w by mail with the CountyAuditor or Counry Recwder of the county where the prope�
Ffirg Dates: 1) Real PropeRy: Must file durirg the year far whifh the deduction is sought.
2) Mo6�le /ManWadured Homes rat assessed as Real Property Mus! Re durirrg the hveNe
6efore March 31 of each year the Ceduction is sarght. G
See reverse side tor additional instructbns and quali�cafions. R�� �
Appfc�n owner �es�tons m reverse siQe) n /�
nuftlbef
l�-�
,�,�d����
Martl� 7, anent year
tt rw, whal Is his I her e�mG share of intemst?
Auditor
Recorder
1 -Z9 iav -"6�y �`tF�-v�. I � ?
�wtpage/ Cantrati'ude6ce0ness unpaid as W Morigaga I Contrarl iMebtedness unpai0 as of b Me app8rsnt Ne sde
dardi 1 artent Y� date W app0�tion legal or eqWtade a�me(t
qoa ❑Y� ❑No
�- rc mMOa �.;�n sort�re wner ew� :aa+se. mc�ta wtm ,v�m
If narne on recoN "s NRerent Nan (hat of appOCant uiEUal
Nameotmm9ag� er �
C �. �
Add� d rtnrtgagce a cantraG se�er (nvnbe`erd sbe'
Name af assignee w athc owner or holder of �rt a
naaress a ass:y+ee (,�ee..e,w speec an
Dces epplifam ovm pnperty in eny oMer
munty m Irqena?
❑ Yes
DeEuction apqoved'c� Ne amouN of:
�_ �_
sigrenne d Camb Auaitcr
I I We certify urWer the penalty of
owner! mntracl buver of ihe afor
ciry. 5ate. aM LP codej
�nc�v
'v_ `��
C on�ria.c�-
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PoMV1 of AtlomeY a M IC 61.1-12-07
lddress W eWia'ned pem.on (number enA 5bee4
Is Cre WopertY in Ouestim: MIweM Assessetl
PSSCSSed
�P� iea�oa � nc s
Has Nc de0ucom Eeen reQUrsted m Wape+ty
fw artmt yeaR ❑ Yes ❑ No
��a
Oata (rtu�tlh.
afM Nat the applinnl is a resident of Indiana and
Date (rrnnfh. deY. Y��)
�Y. Y��