HomeMy WebLinkAboutMortgage_McCandless^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou wn ni Year
:.._ :
FOR DEDUCTION FROM ASSESSED VALUATION
State Fam 43709 (R71 / 6-09)
�' � Presaibed by DepaNnent of Local Govemmenl Friance
File Mark
INSTRUCTIONS:
To be filed in person or by mail witA the Counry Auditor or Counry Recorder oI Ne counry where the pioperty is located. F� � �
Fi/irg Dates: i) Real Pmperty: Must file dunrg the year (or which tha deductlon is soughL ��� Auditnr
2� Mob�7e / Manufactured Homes rrot assessed as Real Property: Must �le dunng the fweNe (12) months
befo�e March 37 0! each year fhe deduction is sought ❑ � ��e�
GIBSO
See 2verse side for adtlitional instruclions arM qualificafions.
Appfrant (owner or oonnart b r- see m,snicDUns an reverse e � i/
� i "
T�ring Distr�s y numGer / legal dewiption Retord num6rl Page numC�
' ��-�� o - a a� - 0 �
1 vahie oF real property a d �Wrtgage / Cantraa indehtetlness unpaid as N Mortgage I Contra
tlrfaR yPar M2�ch 1. turRn� year Oate O( aPP��
/�-/ � �nn
m. wru� s n�s r ner exau
If rurrie on
Name or morcgagea «
below.
Pddress of rtnrtgag� or mntract snder (numbe� and street, cGY. slate, and ZlP cade)
or omer owner ar nmer m rtqrzgage
x (number aM street �Y. �te. and
as d Is Ihe appflont Me sak
legal p equRaWe wmeR
❑ Yes ❑ No
If ovmed with wmewre other tlun spouse. iM�te vNh whom
Does applinnt onn property in any oNer I If 7�es. what munry? I What Ta
munry m Indiana?
.❑Yes ❑No
Deduction
20 _
Si9nawre of Coimry �WEimr
Is Ne property in pues6on: MnuaPj AsSesseO
� �v�v ❑ !±m,�!r w�essed
" .' _' _ _ __-
•i
Dra�rcr NO...a,��,�, � i, � ,
c:,���� �°o. ...33�......
`Q�Li��U�.00 .❑ No
20 _ � 2(1 _ � 20 � 20
�
Date (monN, tlay,
20
I/ We certity utWer the penalry of perjury that Ne above and toregoing infortnalion is We and correct arM Nat the apD����� �s a resident of Indiana arM
owner I contract buyer of the aforemenlioned property on date application is filed. •
7 re(owne � � Date (rtronth. day, ysar)
� i � �/s,/L"� 4 _ / - /�
ot appG�ni (number antl sLee4 �Y. �te, antl
n
or by IC
ACtlr¢s of autlroraed person (number arM streeL �t state, and LPCatle)
Date (rtronN. daY• Yea�