HomeMy WebLinkAboutMortgage_Davis (5)"•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u T ip Year
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R11 / 6-09)
� u� � Presaibetl ty DepanmeN o( Loml GwemmerLL Fiunce
II
INSTRUCTIONS:
Form Aed wiN:
To 6e filed in person w 6y mail with the Counry Auditor or Counry Recorder o7 fhe county where the property is located. �,(!�
Fiting Dates: 1� Real Property: Must file during the year for which the deduction is soughG ���+'�„��y q�di��
2) Mobile / Manufactured Homes not assessed as Real PropeRy Must file dunng the fweHe (72) �}�N C ���r . r�
6efore March 37 of each year the deduction is sought ' V A�fk1�0{��roef
See reversg�ide ta addiGOnal inshucfions and qual/fications. A
� Q�:o� ��i�i' y��'{ - l>. ��:iq:y �
rahie d real qoperty a d ge/ Contraa'udehtetlness unpaid az of Mongage I Con� cmdebleEness �mpa'vf as d Is Ihe app(xanl Ne sde
Ma�M 1. amnt Y� Ma 1� rrt� n` date of aPP�tion �gal w eN�ble owneYt
fJv • ❑ Yes ❑ No
If �ro. what a his l lrer e�t shara of inlelest? If ownatl wkh somewre other than spouse. Udimte w0h wtrom
tl name m iecatl is drterent than ihat ot aOP�C mdrcare beb�v Is tl�e property in Question: MnuaM Pssrssed
❑ Real RoPerlY ❑ �N �
" _ ' - - _ . _ ' . Aloble Fbme OC fr1.1-]
Name of rtprtpagce ar mntract seUer � /� �
mortgagee or mntraq seAer
Name ai assignee w oNrl wmer or hdder of mortgage
Adtlress at asssgnee (numberaiW shee4 dN. s�fe, arM ZIP cotle)
Oces apptimnt oxn proprity
ard
D�-�,,.�,� .�o... a�9 .......
ard No. ....(o34q....
' �``� co . �'17, 077. p8�. .
�uctim Eeen reQUested m propelty
� ❑ Yes ❑ No
COUNTYAUDROR
DeEuctirn appmved'c� the amount of.
20 20 _ 20 20 _ 20 20 _ 20 _
Sig�Me U CwmY Aueitw . Counry Date (month. daY. yea�
I I We certify under the penatty of perjury that the above aM (oregning intwmaUon is We and cortect arM Nat the appliqnt is a residenl of Indiana and
owner / mntra buyer afwementio properry on da applicalion is filed.
Sign w o e 0 na � Date (monffi, daY. Y'��
- �
" ent addrnss d aPP��t (numberentl shee4 �: , end 2!P cotla)
/IJ �1 �./ .5�
auNO�O by OWy exearteE PovmlW Attornay w Cy �C 61.1-12-0.7 Date (monN. day, yee�
PddressofaWiafvedpersa��numberaMSbeeL�+ry.sbte.antlLPOOde) . � '