HomeMy WebLinkAboutMortgage_Ripke"'n �ATEMENT OF MORTGAGE OR CONTRAC H�EQ� Coun
• POR DEDUCTION FROM ASSESSED VALUA�1 ���
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� n Stata Fortn 43709 (R11 / 6-09)
� �. �;� � ��� o� � ��� F� �UL 13 2011
�NSrRUCnoNS: c ,�
To 6e filed in person or by mail wifh the CountyAUddw or Counry Recorder o/ Ne county where the 's located.
Fifing Dates: 1� Real Property: Mus1 �le dunrg the year for which the deduction is sought. n��� �TpR
2) Mobi/e / Manufactured Homes rrot assessed as Real Proper7y: M �Ie��1�Qi�eN€(12) monfhs
6efae MaicA 31 ot each year the deduction is sought. G�
See reverse side (or additional instructions and qualifications.
r Arg ois� - Key n,moer � lege� aesa�non �
- O .
d raNe U pvlY as d Mor(page / Contraa N
M2�tl� 1, armnt yea MaTh 7, arterrt yrar
7'
I( m, what a his / her e�act share al interest?
It nartre df mmrd i5 diRe�an Nan Nat of app6mnl, mdinte beqrr
Nartre of mortgag, or mntraG seller � .
a«ignee w oNer owner w
Year
Fle Mark
Form f�ed with:
� CountyAuditor
❑ County Remrder
wmber
unGaid as of I MM9age I ContrerS'vdebtedness unPaid as d I Is Me aPP�t tice sde'
Oate o( tPP��b^ kgal or eN�e mmeR
❑ Yes ❑ No
H ow�ed wiM sortxww�c dher ihan sW��. iMkate wifh wMrn
(number aM stree� ci(}; state, aM ZIP code)
morigage
sbte,
Oces appfinM own property in any aNer
tounry in Indiana? ❑ Y25 ❑ No
Deduc7on apprweO'c� the amount
�_ , �
$ig�aWR o(CamlyAud'ROf
If yes, wfiat munty?
COUNTY
Fz����
Me WoPenY in 7uestion: MfwwaOy Ass¢sed
�I Property � MnUallyAssessed
WhalTamgOiSU'u+'- ` �
i �
— �yP���, t�s'�''"� �
�UDRO �mj.l-� �J
� G�''�Gr`��� ������° �
�.0��-3151
cV
�RY
❑ No
I/ We certify u�er Ue penalry of perjury that the above and foregang infortnalion is We and corred and that the applinn[ is a resident of Indana and
owner / mntract buyer of the aforementioned property on date application is filed.
SignaWre , /s fiAI name)� ^ Date (monM, day, ysa�
sbfe,
eseai�W PorEr of Attomey rn by IC G7.1-12-0.7
'r o��-1 lnti./5�50 S C� W° N
ME2ss W author¢ed person (numberaid 51ree4 Ctiy. sbfe, entl LP cotle)
Date (rtpnM, day, yee�
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