HomeMy WebLinkAboutMortgage_Brooks� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou wns r
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R71 / 6-W )
�,,,, Preuribetl M DePartmeM oi Lxal Govemment Finanr.e -
INSTRUCTIONS: � MA�e �ta�C Zp10
To be filed in person w by mad wRh !he CounryAuditor or Counry RecoNer ot the wunty where the pioperty is locafed. F� fl� �:
Frlirrq Dafes: 1) Real Property: Musf file durng the yearlor whicA the deducfion is sought. �'��uditnr
2) Mo6Ae / Manufectu/ed Fbmes rwt assessed es Real Property: Must file dun�g Ne hveNe (12J monfhs
6e/ae March 31 o/each year the deduclion is sought. QIB$0 () N ���� �
See reverse side /or additionel insWCffons and qualifications.
�pfimnt ( «contraU r- see rasfri
u'vg Distrirl ni
�pseE rah�e d real pfopeny as ot
mM 1. a+�Cit iPaf
Iq, whet IS h's ! hu eYatl sharo of Intere5t7
sgal desQiptmn Rewrt1 rwmber Page number
�1-1-b�-�o�1-DbO. 33$-t�.�. �.o � o �oc
rtgaBe / Contract IMebtetlness unpaiO az N MMgage I ConSa�i uMebtedness �mpaiA as o( Is Ihe appA�anl Ne z
rt3� 1, artent yeer date of appWation legal or epuilaWe owr
tl name m femrd'a Ntfe2nl than Ihat d aGG�^t mdinre Eebw:
smm, aM LP code)
hdder N mor�gage
(rwm6ar aM street �Y• state, and LP co0e)
epplitanc wm Wnpnty in any dhc
y N Indana?
❑ Yes
cOm app�oved in Me amount ot
20 20
No
1! ownetl wiN someone oiher �han spouse.
properry T OueSfiac Mnua%Assessetl
Real Ropertv ❑ /vmuanrasses�
0.loble Flartie QC 61.1-
'
i
� �a� �....��
Di�"�l �0,_..
Ca� � \O
COUNTYAUDROR
20 20 20 20
Counry � R
aqQ�...
_. .es No
�
I/ We cerVfy urWer the penalry ot perjury Nat the above and foregoing infortnation is true and cortecl and Nat Me applinnt is a resident of IrWiana a�
owner / wntrac] buyer of the aforemeirtioned property on date appliration is filed.
iriawm towneYs hN narne) Data (month. daY. Yee�
ot auNOraed person
rM snee4 �' sbte. and ZIP oode)
, ¢� �C,��- �,02 nGJ i �
JASt�neyorbylC67.t-72-0.7 -
StreeS �Y• ��e. and ZIP Code)
Qate irrwviM. tlal: Y��