HomeMy WebLinkAboutMortgage_Marginet (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__,. = FOR DEDUCTION FROM ASSESSED VALUATION
• Stdte Fortn 43709IR71 / 6-09)
�' a� f P25uibed by DepaNneM of L.oml GovernrtreN Firence
a
INSTRUCTIONS: �yw�
To 6e (led in person or by mail wiN the CountyAud'ROr or Counry Recorder of the county wf�e2 Ihe property is located. � J V��009
Fifirg Dates: 7) Real Property: Must file dunrg fhe yaar for which the deduction is sought. � Counry Auditor
2) Mobile / Manufactu2d Hortres not assessed as Real Pluperty Must fi/e dunng Me hveNe (12J months
before March 31 of each year the deduction is sought � /� �Qu Remrder
See reverse side la additional insVUCtions and qualifications. 'J
Aoo�nt (mvre� u oontrae buyer - sv4 resLirtiwa m reverse side) . . �
s��
II no. what q his / her exarl share ot interesl?
If fwr�a m mmd a QRerent than that ot appOCant, ind'uate bebw
V Rera�d number Page numDrJ �
�' 0100 -00/. O L(o -o e�- / a-DD 7 t�-,S
4debtedness unpaid az of Mongage I ContracY indebtedr�s unpaiE as of Is ihe epp0�ant Ne sole
v aate oi aOP��� legal or equitada rnmeR
QQ ❑Yes ❑No
If ovmed with someone other ihan spouse, 4Miote wtth whom
Is ihe property in purstion: Mnua�y Asse55e0
-� r ❑ Real ProPenY ❑ ?^"!�a�Y As� . . .
.<.,...,.......v�..,-�c,....„ ............. J y� '/�YJv�L..C..+
i �
Add2a of mort�agee w canVad se0er (number arM shee4 �Rl: stete. arM ZIP code)
Name at assuyiee w ottwl owner w hdder af mortgage
Addras5 of assignce (num6er antl street, tlry, smte, and ZIP cotle)
Ooes e�i`ant ovm pmperty in any oNer If yes, what munty7
munry m IndFana? r-� _ r� ..
amount ot:
20 � 20
1/ We cerOfy underjthe penalry of
owner I contract buyer ot the afon
Cd�111: Y � /d I I .]►[!7:3
�— - - —
�no�.......
Drawcr N ... .
......
Card NO. ..�01,..�.r...........
� proprfty
_ .,;,, ❑ No
20 _ 20 2b _ 20 20
Counry Date (monm, daY. Y��
the above arW foregoing infortnalion is We and correct and ihat Ne applipnt is a resident o( IrWiana arM
property on date application is filed.
� Date (monfh. daY. Y��
eSiCerrt edtlr�ss W S�itant (number erW aty, stale, ard ZIP oode)
�/S'�O W�T S S�v-� fl�E'�SU/LCE IN, �-1 ��S
m author�d by Euty executetl Power IN AuorneY a M IC 61.1-72-0.7 Date (month, dzy, yea�
ess of a W�w'ved person (number aM sbee4 �y: slate, and LP cotle) .