HomeMy WebLinkAboutMortgage_Gambrel (2)°•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
� FOR DEDUCTION FROM ASSESSED VALUATION
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• Sfate Fwm 43709 (R71 / 609)
S P pry�p� y�, pe��nl of Lool Govemmenl Frence
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wsrRUCnoNS:
To 6e filed in person a by mail vnth the CountyAUditor or County Recorder ot fhe county where tAe pmperty is located. Fq� fl� �:
Fil'rtg Dates: 7) Real Pmparty Must fi/e dunng the year for which the deduction is soughL �Q N`�l ��U nty Auditor
2J Mo6Be /Manufactuled Homes irot assessed as Real Property: Must file dunng the fweNe (12) months ❑
befoie March 31 0! each year the deduction is sought. � Counry Recorder
See ieverse side lur additional instructions and qualifirafions. '
Avafi�n�(°� orconhacay�er-sea�°°� onre sde) // (.31dt34N C�UNfiY A-ll�lfi@A
/R 1 nn-� m i.., v �0 �YY7 ��1 o,i' ��
Key num0er / legal Oesaiption
r��-- a�-��-o9-ioo -c�y. �y9-
�f 2a1 poperty as of Mo age/ ContraG inde6leEness unpaiG az of Mort
year . Mar� 1, wnent�ear_ � tlate
ro.
name m remrtl 8 ddterent Nan Nat of app6�nt, indifate bebw:
Name ot nqrtgagee ar mntract seller
AGdress o1 mort9agee u mntrsct
awner w
stete.
dry, slate. antl LP catle)
Does epplipnt ovm praperty in any oNer
county m Ind'ana? ❑ Yes ❑ No
Deeurdrn aPWOVed ci tlie
20
SignaMa of Cowb Autlimr
20 _
Remid number
h Ne epp6rant Ne sde
legal w equitade ameR
❑ Yes ❑ No
It awned wiN someone dher Ihan spouse. ifdrcate wlth wtwm
If yes, what munt�!� VYhat Tadrg Distric
COUNTV AUDITOR
20 20 20
7Ies�,tl�e ProOertY in QueStion: MnuaDYA55e5uV
Ili,RealRoperty ❑ArmuallyAssesscd
T Modle Home QC 6
reQUested an P�Y
❑ Yes ❑ No
20 _
Date (monfh, day. year)
20 _
I I We cerafy uMer the penalry of perjury Nat Ihe above antl foregoing infortnation is W e and correct and that Me applicant is a resideni of Indana and
owner / mntract buyer ot the aforemerrtioned proDerty on date application is filed.
;�(owien NV reme) /t Date (nmfi. daY. Y��
i'M /` C%
1 ' enl adCrass of appGmnt (numDer and 4 dry state, and ZIP mIe
;//J_�9 / �J ii 7 � S ,i��n svr�'�P �.� '—f��lnS
W
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of aWior'¢ed person �number aM street �y, sYdfe. an0