HomeMy WebLinkAboutMortgage_Martin (6)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ou hip Year y
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
. . State Fwm 43709 (R71 / 6-09)
�' Presaibed by Departrtient o1 Loml Govemmenl Friance
File Mark
INSTRUCTIONS: C �
To 6e filed in person or 6y mail vnN the CountyAuditor or Counry Recorder o/ the counry where the property is located. �
Filirg Dates: i) Real Properry: Musf file dunrg the year (of which the deducfion is w�ght Auditnr
2) Mo6de / Manu(acfured Homes not assessed as Real Property: Must file dunng the IweNe (1�18&(tib CO NT D
6efore March 31 o7eacAyearthe deduction is s�wgAt County Recwdu
See reverse sMe !or addrtional instructions and qualdicatbns.
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Taring OisCic�/ rvanber / legal desai0 Record numErl Page numMi
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d real a o( Mortgage/ Contrayara irMeWeErress unpaid a W Mortgage / Conraa iMehtedness unpaid as d Is �he appGrant the sole
i1. Year Marti� 1. I J(,J O Eate of ePPGration legal O YeSe ❑ No
II m. Miut is his l lrer end share of interest? If wmed wiN sammne ottier than spouse. indzate wtth whom
If �wne on �ecorE is tliHerent Nan Nat o( app6cant, ma'vale belaw. Is ihe property in QuesUon: MnueOy Ass¢sed
❑ Real a(oa�+ri � A^^�v �
Name af rtnrtgagee «mntract se0er
ACdress of mortgagee or oontract sWer (num6er end svee4 �: sate, aM ZIP wde)
Name ot assignee w othr! owner w tmlder W nqrtgage
AdC�ess ot assig�ree (num0er an0 strcef, ary, slare, and ZIP code)
r.� 2, - 3 -�a
OcesaPW�antownWOGenYinanyoNer U—'-"'__••,
munry in Ind'ana?
❑ Yes ❑ No
ction approved in tha artwunt of:
2� 20
Si9raMe or Counry Audilnr
I I We certify under Ne penalry of
owner I conq$ct buyer of Ne afon
FWI resident
tl
P
Address of aWror'ved person (numbe� aM streo4 rily,
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