HomeMy WebLinkAboutMortgage_Harvey (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
FOR DEDUCTION FROM ASSESSED VALUATION
ir- '
� n Slate Fortn 43709 (R71 / 6-09)
�' 1 Presaibe0 by Department oi Wwl Govemment firence
�STRUCTIONS:
M mea a;m:
To 6e filed in person w 6y mad wiN fAe CauntyAutlitw or Counry Recorder of the county where the propeAy is locafed. ��
Filirg Dates: 1) Real Property Must file during fhe year (or which the deduction is soughL ' ZCo�ry Audimr
2) Mobde / Manu(acN2d Homes rrof assessed as Real Pmperty Musf file dunng [he tweHe (72J months C �{y Recorder
6e(ora March 37 of each year the deduclion is sought '.
See reverse side lor add'rtional insfruUions and qualrficatbns.
aMr me�..msormnrradbuver-seeresvraonsmreversesCe) . OR
tt no. what's his! Mr e�
If riame on
Key number / legal Oes
�z(o-/�_3
wrre�� yem
iha� of app5canl trMir�ate bebw:
Nam¢ p( rtnrtgagee nr cpntract utler
AEaress or mortgagee «contraa seAer p
Name of assi�ee w other owner w haN�
AAtlress o( assi9nee (number aM street
P T E ni F
Ores epplimnt wm pfopeny in any oNer
munry in trd'ena? ❑ Ye5
I
DeduGim app�oved h� ihe amoum of.
20 _ 20 _
Reco�d
V ...l. ✓ oa — ✓ �— ♦
unpaid a of Martgage / ConttaU rtMebtetlness unpaid as d b Ne a
aa�e or avv��� �� �
5feffi. aM ZIP cade)
riry. s�ate, entl ZIP code)
3�,3-
20 _
C� I —V
I I We certify �nder Ne penalry of perjury N t Ne above
rnmer / mntract buver of the aforemerMioned property o
Pr�son
ap�ranl
W Attaney rn Gy
K ownetl wiM someone other tl�aR spouu. itdirate wiN wlrom
�e nQum � �
� /
anl tl1e sde
�ila6le ame(.�
Yes ❑ No
Is Me {poperty in puesDm: MnuaOy Assessed
�eal PropeAY Q Armually.Assessed
Z
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couNrv
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_ ia --id �'a y
20 I 2(
Da1e (irotlh, tlaY• Y��
regoing informalion is We and cortecl arM iha[ Me applirant is a resident of IMiana ard
applicalion is filed.
Date (month, Eay, yea�
aWror'¢edpersm (numbalarWstreeLdry,Sfate,anOZlPtode)
Date (monN, tlaY• Yze�)