HomeMy WebLinkAboutMortgage_Fried^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ � FOR DEDUCTION FROM ASSESSED VALUATION
� State Form 43709 (R7716-09)
S,,,, 1 PresaibeE by DeP��m of Local Govemment Frence
INSTRUCTIONS:
To be �led in person or by mail wiN Ihe CounryAuditor or County Remrder of the counry where the property is located.
Filirg Dates: i) Real Prvperty: Must file durirg the yrear (or which the deduction is mughf.
2) Mo6r7e / Manufactured Homes irot assessed as Real Property Must fi7e dunng fhe fwefve (12) months
before March 37 07 each year the deduclion is saqht.
See 2verse side for addifional insLUCfnons arid qualifications.
IMP�nt(o or¢ntraUbMyer-seeresJt�tourpmr@�ersesjtlql
J ❑ Counry Recwdrer
G�BSON
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- _ /� G('>- UO.�%d�- O�-/ �C.
vWUe d real propeny of Mwtqage I Conbaa'udebtedness unpaitl as of Mongage ! CmVar1'vMehtetlrress unpaitl a d 6 Ne epp�ont Me sole
March 1, anmt year Mart�h 1, a�rtent yeer date of appGCatim / legal w equita6le ownel.�
CQ ❑ Yes ❑ No
If m. what h ha / her eraG share of interestt If wmetl vriN someone other ihan spouse. 4di�te with whwn
tl iurtre m recwd a d�Reren[ Nan Ihat ol apP��. �inte 6ebw Is C�e property in question: Mnua%PSSess�W
❑ Real Propeity ❑ Mnuaily 0.ssessed
mortgagee w mntrarl seller /-� /� � �
C� ll/1
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of nqrtgagce or mntract seAer (numher and streel, ciry, sta�, aM ZIP wde)
Name of assignee aWlw w r w hdOer W mortga9e
AdCR55 of asagnee (num6eraM stree4 u:Y, stefe, and ZIP Code)
Oces applinnt a.m property in any ofher I( yes, whs
muntv in Ind'¢na? r-� r-i
the amount ot
20 � 20
District?
COUNTYAUDROR
G
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���m 110��
�������, ��30
20 _ 20 2b 20 _ 20 _
�reWre W Crnmb AudP,w Counry � oate (rtonth, daY. Yea�
I/ We cert'rfy uMer the penalry of perjury that the a ve and foregaing infortnalion is We and cortecl ard that Ne applicant is a resident of IrWiana arW
owner I contracl buyer ot the aforemertlioned p rry on date applin4on is fileA.
�� rS M1ID rtre) _— �[e (rronfi. daY. Yge�)
aen[ aCtlr�s�f aPP�t (nun}6er and slree4 aY, �te. arM ZIP oode)
� � � (�L�i �L`ZG✓�i _�(�� �
auNOmed Ey EWy ezecutetl Power of AttomeY & M IC F7.1-12-0.7
t oi a Wnrrzed persm (numbe� a�M shee; �y. slate. antl LP cotle)
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