HomeMy WebLinkAboutMortgage_Henrich""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Fortn 43709 (R71 / 6-09)
i
�' u�. Pfesvibed by Departmertl of Laml Cawemrtrerrt France /�
INSTRUCTIONS: �
To 6e (led in person a by mail with the CounryAuditor or Counry Remrder ol Ne county where the property is located.
FiNng Dates: 7) Real Property: Must fite dunrrg the }rear for which the deductlon is soughG
2) Mo6i/e / Manufactured Homes rrot assessed as Real Property: Mus! file during Ne twelve (12) monMs
6etore March 31 0/ each year the deducUon is sought.
See rBVerse side loradditbnal insWCtbns and qualificataons.
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�
f vdlue of eeal pfoperty as W
p oper y
amfrtyear
iU. wnat
nartie an
C� un,t rlt��r
Counry Remrder
nEer / al desaiption // Remrd number � Pape
�� � -oa o �
' Monpage / Contract Intlebte0ness unpaid az of Mongage / Con�azt i�MebcednPss unpaid az d Is the epp�nt Ihe sda
traz
Mert3i 7, arreirt year Cate of appGfation kg21 or drytilade wmrll
❑ Yes ❑ No
If owned wiih someorc other �han spouse. 4d'xate with whom
wm. h�Cinie belmv. Is P�GeRY in Question: Mrnia9y Assessed
Real ProPertY ❑ %vmuall)'Aa�s�
Name of rtnrtgagee ar mntrad seDer
Address of rtnr4�agce ar mntraa seAer u end streeG laY�
Name ol essignee w oNer owner or hdder of rtqrtgape
AOCress ot assi,g�ee (num6eraiM streeL �Y. smt' — ' __ _ ' - _
uces app�m wm yoperty m any omer
munry m Ind'ana?
❑„� ❑N,
DeduUion apprwi.M in ihe amount
ao��
S�Qa
��P�(ne��Qn
L.l UL�`�a" 1..�'�'`�
�vng oiso-vl� I r+as ms aea��n teen rea��d o� ProvPm
tar wrrent YnaY.+ � Yes ❑ i
20 _ 20 _ ,�(, I c�O � �-� � � 20 _ 20 _ 20 _
Sig�anrte d Camry Audrtor Counry Date (month, daY. Y��
1 I We certify urdes the penalty of perjury Nat Ne above and foregoing infortnaUon is trve and mrtect arW that the appiinn[ Ls a resident of I�iana and
wmer / mntracl buyer of the aforemefrtioned property on date application is filed.
(ownerslull iame) , _ Oate (monfi. daY. Ye�
Full rnsitlent a0tlr�ss of ap I"cant (numDer antl sbee4 tity, sfate, aMllP cd
� 3
Person authoriztd Dy duly exewted Power ol AROmey m q IC G1.t-t2-0.7
Address of aWia'¢ed person (numberaM shee; ciry. state, and LP cotle)
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