HomeMy WebLinkAboutMortgage_Reising"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__,_ � FOR DEDUCTION FROM ASSESSED VALUATION
~ Slate Fwm 43709 (R71 / 6-09)
`,.,� Presaibetl Gy DePaRmeM of Loral Govemmerk Frwce
File Mark
�NSTRUCTIONS:
To be filed in F� �� �:
person or by mail with the CountyAuditor orCounty Recorder o! fhe wunry where the propeAy is located. ��
Filirg Dates: i) Real Property: Must file dunng fhe year Por which Ihe deduction is soughG �� �
2) Mo6ile / ManufaUured Homes not assessed as Real Property: Must h7e dunng fhe twelve (12) rtronths
before Marctr 37 oteach yearthe deduclion is sought R �
See reverse side lor addilional instn�clions and qual�cations.
Appkanl(o�vner�w�ntrarl6uye�-s� �reve�e) �n + ^ I
T2101g �iSficY KE _ / =tlCSfflPtiOn � �/W ��� � RCtOftl numyq[ P2.(� \ � '
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v v
�d���� ��,��������b�� ��,�«���„�� �
Maich 1, acrent ypr Ma 7 rte�rt yea ' 1 dalc o( appGmGon legal a equitable
� !/ ❑ Yes ❑ No
It no, what's ha I her eract share of in[erest? If owrrea wiM someone aher than spouse, iMicate wiih whom
If rwne on iemd s Eitterent Nan Nat of appi'ican4 uWvate 6eb�r. Is tl�e property in Quer.GOn: Mnually A5se55e0
❑ Rea� a'opertv Q ,4nnuaM Psse� . . .
Name oi rtiortgagee n
mntraa seller (num6ar and shee4 cdy, sfete, aM ZIP code)
w hdder ot frortgage
Adaress of assignee (number aM�strer' "' _ _._..
Does appli`aM own praperty in any otl
munryinlMana? I-1 .,_'
f7�7
SignaMe d
Di-a,���r ,�o.. ao��.......
vn[ of
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� , 3�.0-00 .� _
Counry
Has Nis detlutli
fOr wrtHtt Yea(.�
20
stea a+ v�r
Yes ❑ No
Dale (monfh. daY. �a�
rZ�7
I I We certity under ihe penalty of perjury that the above arM foregoing intormation is We and cortect and that the appiinnt is a resident of IMiana and
r I contraa buyer of Ne aforemeniioned property on date application is filed.
re /s hN pe e) � Daro ( day,
�.�r n Qn..,_,._ Io�� ��`�!
by IC 61.1-t2-07
ldCress of aWmr'vtd person (numDerantl sbeet ary. sb(e.
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