HomeMy WebLinkAboutMortgage_Whitehead (3)�
^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,_ • FOR DEDUCTION FROM ASSESSED VALUATION /
� S1ate Form 43709 (R11 / 609) V
�' ! Resaibed M DePartmeM of Loral Govemment Fu�ance
�w 1�0
wsrRUCnoNS:
To be lr7ed in person a by mail with the CountyAUditor or Counry Recorder o( the counry where the property is lo� �
F7ing Dates: i) Real Pmperty: Must file dunng Ihe yearlor which the deduction is soughL � Counry Auditor
2) Mo6i/e / Manufactured Homes �rof assessed es Real Property: Must file dudng the tweNe (12) months /� �����j
6efore March 37 of each year the deduction is soughG � l. �.� �%�Y R��
See reverse sitle for addiLOnal instnxtions antl qualificafions.
�n ar� T'/ /1 �reY//e) ��...�.�Y�'^/
ii �// //I/i� l 1 i' o. DLJ � �l._.__..
I���--'�..T�
If riartie m remN is dtlfaen[ Nan that ot aPP�t
rrame or�gas� «ow�o-ae
��Ww
��� O- �0 . ��o7'Qo�--�
:/ ContraG GitlebteEness unpaid as of Mongage I ContraG
a�rmnt yeffr date of apPGcation
Oelo�r
If awned wiN someorie oih� ttun
Address of mortga9ee or cmtraa seAer jnum6r� end sveat u�: state. eM ZIP code)
Name ot assignee w oNer owner m Imlder o( mvigage
AOCrew of ati�ee (numDe� eM strreL dry. sb1e, arM LP code) /� �/ —� I//
a
ooes apd�m o+n, wocem �n ar�, at,� u res. �,a� oou�c�n _ w�, ra�re oao-�aa
counrymind'ana? r1...__ ..r-i_ .. _. _
�� �
zo _
��� ��
. v
L� �
.
Dra�ver \ ..................
......
c���a �o. .....sa �,
INTY
���
zo
/ G S��
unpaitl az o( Is Ne eppfimnt Ne sole
rn-� kgal a eWila6le ameR
YV I n Yes ❑ No
RPaI PrOperty � Amlually Asse55ed
awa� rro� nc ��.
� %���
Has Nis deEuctian been re7uestetl on paperty
for wrtem yeaR �,_ �.
�
��
�
I/ We cero�y unaer Ne penalry of perjury that the above arn1 foregoing infortnation is We and cortect aM Nat the applipnt is a resident of Indiana arM
I o.mer % contrad buyer af the afwementioned property on date appiication is filed.
SIg�Nre (owne/s !W reme) n Date (rtnnfh. daY. Y��
tlty, stare, antl ZIP oode)
by OWy exetuted Powei
ACdress of autha'veA pereon (numberantl sbeeL �y. s+ate. and LP rode)
Date (monN. daY. Yea� _