HomeMy WebLinkAboutMortgage_Tuley"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
>__ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sfah Fortn 43709 (Rit / 6-09)
S,�,� � Presaibetl Oy DePertmeM ol Local GwemmeM France .
INSTRUCTIONS: Cp
To be filed in person or by mail wifh fhe CountyAuditor or Counry Recoider of the county whe2 fhe propeify is locat� C f
Filirg Dates: i) Real Property: Must fi/e during Ne year lo� which fhe deduction is sought.
2) Mo6Ae /Manulactured Homes no1 assessed as Real Property Must file during [he fweNe (12J monthg ,�j.
before March 31 oI each year the deduction is swght.
See reverse side for adtlifional instrucGons and qUalficafions.
Appfimnl(ownerarcpRt�ar16J4'ef'seeS9�Y'mu �971
�
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1. tl�t year
If no, what is his / her e� share ot inte�est?
name on recoN a C'tlferent ihan tlut ot app4oni,
ame of rmtgagee ar oontraa seller
Counry Audi[or
CaunN Recorder
�o-�o�.`� -aai �
I Contrafl indebtetlnps unpai0 as U Mortgage I Contracl iMehtedness unpaid as ol Is Ne applicant the sde
n t m Eate of aOW�tion Mgal n eQuitahie oxnM
) �/ � ❑ Yes ❑ No
If owned with somea�re aher ihan spouse, indicate wah whom
� � ? .
Address of rtnrtgagee w contracl se�er (numt--- ' r/
Name of assgnee w oNer mmer w holder W i � ��� � GI
�
AECress of asvgnee (rium0er a� sheet �Y. s
WoGeRY
��,��5
Is Ne p(operty in qunstion: MnuaP� As=°��
� Real Ptoperty � Mnually A55essed
Has Ihis deduGion Deen requested on P��nY
for wi,ent yraY! ❑ Yes ❑ No
COUNTYAUDROR
Deduction approveE u� the amount of.
20 20 _ 20 20 _ 20 _ 20 20 _
Sigrenue of CamN Auditw Counry Date (month. tlaY Y��
I/ We ceNfy uMer the penalry of perjury that the above antl foregoing infomialion is We and correct aM that the applirant is a resideni of IrWiana arW
owner I mntract buyer of Ne aforementioned property on date application is filed.
Sig e/s full reme) � Date (monU�, deY. YeaA
F ' ent a0drev^ ot appGpnt (num0er antl street, dry, state, aM ZIPmCej
S7�-fS`Sc�+-c /t7f� wcs7' LNrsdillG �.� GCs�
auNOirzetl Oy dWy esecvted Pawer of Attmiey m by IC 61.1-12-0.7 Date (mmN. Qay, yEa�
ACdress of author¢ed persrn (number aM sbee; ciry, sfafe, and LP aode) .
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