HomeMy WebLinkAboutMortgage_Ricker"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C ow Year
,_ . FOR DEDUCTION FROM ASSESSED VALUATION
SFata Fwm 43709 (R71 / 609)
,,,,� ` Presvibed by Department of Lacal Govemment Fuiance
Fiie Mark
INSTRUCTIONS: A Fortn a ' .
To 6e filed in person w by mail with fhe County Auditw or Counry Recorde� of the counry whe2 the property is located.
Fi!'mg Dates: 1) Real Property: Must tle durirg the year for which Na deduction is sought. � Co ty Auditor
2) Mob�7e / Manufectured Homes rrot assessed as Real Property Must fiie dudng the tweHe (12) months
6efore March 37 0/ each year the deduction is saqht. � Recorder
See reverse side for adtlifionel instructbns end quelficaGOr� GIBSON
Aoofram (owriecor contraU buver- Jee ras7tiUlbns on reverse ' . .
Tarirg DLstr'n1
nss�sea �r� asm
1A1e�d� 1. ym
tt m, what is his / t� esad share o
tt rartie m n.md's dAte2nl Wn C
Name of rtartgagea or cmtract Ili
AGdress of �
Name of assignee w other owner oi
�a�a,�
�y p¢scip(ipn Remrtl �wmber Page numbu
- 7- - - bo . 8- o a � �SO
7age / Contrau 4debtedness unpaid as of MMgage I Con� udebtedness �mpad as d Is Ne appBrenl the sde
h 1, airmst yrar aate or appfimtion legal «eQuitatle amM
j ❑ Yes ❑ No
tt awna0 wiM someona omar tl+an spouse. udirate wflh whom
h�0iram Eebvr.
M sbeet �: �le. anO LP aode)
eny oUa If yes, what munry?
Yes ❑ No
om��, �a H me a�,u oe
� � �_ � p
U Camb nuahor
I/ We cerVfy �er Ihe penatry of
owne,µeantrad buyer of Ne a(on
Puson
zo
Is tice propercy in Question: Mnua�y PssesseE
�eal P�vpertY Q Armually Ass�ed
,�tT��[ �S C!« � DA� v i�1 � --�
�p/o - �sc�
� ��w.
the above antl foregoing infortnatlon is we and correa and Nat fhe appGnnt is a resident of Indiana arW
property on date application is filed.
�ate (monm. dar, r�A
and slreet ary, stare.
Ey IC 61.7-12-0J
person (number antl sbeeG uN, sb(e.
� �
Data (monN. OaY. Y��
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