HomeMy WebLinkAboutMortgage_Leary"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,__ : FOR DEDUCTION FROM ASSESSED VALUATION ��$
• State Form 43709 (R71/609) Q
� 1 Presaibetl by DepartmeM of Local Govemrtrent Finence ��
File Mark
�VSTRUCTIONS: '
�;�;� s o 20» F�,���,:
To be filed in person w by mail wifh the CountyAuditor or Counry Reaorder of the counry where Ihe property is located.
Filirg Dates: 1) Real Pmperfy: Must fife dunng fhe year Por which tha detluction is soughL �a � n Counry Aud"rtor
2) Mobde / Manufactu2d Homes rpt assessed as Real Property Must file dunng (he twe e( m ths
6efwe March 3f o(each year the deduclion is sought County Reoorder
Seereversesidetaadditionalinstrucfbnsandqualifications. �����`�i��`7UNTYAUDITOR �
seemshi;fionsmrerersesitlrl „ ��n
Diriia
Y eeal YoPery as
'F�
Ii rq, what is his / her exaa
�er/legaldesaivtirn .
�-7-r3/ -r�0� C��/
�MOr�qaqe/Contraa'uWPbteGnrsSUnpa' asof
If name m reoptd ig 6tf¢r¢nt �han that of aDP�^C �ipte bebw:
Name of mortgagec ar mno-xl seller
w mntrap seller (nuni6ei and sfree; ray, stare, and ZIP code)
or ower owner or nme, rn narcyase
nneress ot assgnee (numDer and street �3: s+ate. arw t�N wde)
Page number
unpaid as d Is Ne appfrcant the sde
legal or equitade awnM
❑ Yw ❑ No
wiN someorie aher inan spouse. iMicate Mitli wiwm
Dces apFJ�nt own property in any oNer I If yes. what munry? I W�al Tanng C
counry in Indana?
❑ Yes ❑ No
perty in Vurstion: MnuaOy Asessed
a(openr � Annua�Nwssessed
R�&�� ��'�i
cRys��. �
� �-5q35
20 I 20 I 20 I 20 I 20 I 20 I 20
�
I/ We certify uMer Ne penalry o( perjury that ihe above and foregoing intortnatlon is true and wrtect arW Nat the applinnt is a resident of IrWiana a�
ovmer I contracl buyer of Ne aforementioned property on date applicalion is filed. '
�n�re (ownefs MI reme) � n Date (month, day, yea�
state,
Person aut7rorizeC ty Cuty executetl Ppyler ot Nto(�fi y m by
AddR55 of aNha'v.ed person (number arnd Sbee4 dry. State. and LP mde)
Date (monfh. aaY. Yea�