HomeMy WebLinkAboutMortgage_Winkler"'� �ATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS� coun
__ ; FOR DEDUCTION FROM ASSESSED VALUATION �
State Fartn 43709 (R71 / 6-09)
,,�,� � ResaiheE by OepaNnenl 01 Local Govemmerk Finance
lNSTRUCTIONS:
To 6e lled in person or by mail with Ne CounryAUditor or Counry Recorder o/ the county where the property is located
Filing Dates: 1) Real Property: Must file dunig the year for which the deducfion is mughf.
2) Mo6Ae / Manufactured Homes lat assessed as Real Property Must ne dunng the lweNe (12) months
bePore Ma�ch 37 0/ each year the deducUon rs sought.
See reverse side 7of addiLOnal insfructions and qua/dications.
Ta�drg DistruY � Key�w
a -c
�������
Mach 1. armnl year
� If ro, what ks his I her exaU share of inteiest?
It name m remtl ¢ Gi(tem�t Nan Nat of aPp6car
Name of mortgagce or conUad seuer
Address of mortgagee a contract seller (numbei
Name of assignee or other owner or holtler of mc
�d�
munry
Db-i�o- t�oo-oo� •
Monpage / Contraa mdrbtedrress unpaid a af
March 1, ¢rtreM yeer
It owned wiN
Dra�ver NO.o°�,Ol�...........
� (numberand 51ree4 ci�t sla . • T - � Q( IOC'� . '
' CaCd \O . .....................
pmperty in anY other .lf/.L� �.�( I), �
�K✓J/✓•-�_
Yes LJ !:_
�CountyAUditnr
C�� Recorder
a d h Ne app6mnt Na sde
legal or equilade ownel.�
❑ Yes ❑ No
mtlicate with wlqm
Is Ihe praperty in qurstion: MmuDy Asussed
❑ Real Property ❑ Mnually Assessed
Nas ihis deEuction been reQuesteE m property
br wrrent yeaR � Yes ❑ No
COUNTYAUUROR
Deduaion approved'm tlre amour¢ oF.
20 _ 20 20 _ 20 20 20 20 _
Sgriature of CounryAUdimr Counry Date (montl�. day, yea�
I I We certify under Ihe penatty of perjury that Ne above ard (oregoing infortnalion is W e and correct and that the appiicant is a resiCent of I�iana and
owner I contracl buyer of the aforementioned property on date applicabon is filed.
" na owne/s full name) Date (martl�, day, yea�
�' �r
II � ent a0decss appfran[ numEar and 4�; sWte, and Z!P ootle) `
4?b
Person aulhoratd by duly esecuteC Powef oflWomey or by IC 61.1-12-0.7 Date (monN, day, yea�
AdOres M authorrzed person (numbereM street ary. sb(e. and LP wde) .
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