HomeMy WebLinkAboutMortgage_Lamey"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�r--.
FOR DEDUCTION FROM ASSESSED VALUATION
' Stata Fwm 43709 (Ri t/ 6-09)
�,�. PresaiCeC by OePartmeN of La�l Govemment Flrerrx
wsraucnoNS:
To be filed in person or by mail with Me CountyAvtlitw or Counry Recorder o! the counry wheie the property is loca(� N 3
Fifirg Dates: i) Real PmpeRy: Must file dunng Me year Por which the deduction is sought.
2) Mo6Ae / ManuFactuled Hanes not assessed as Real Property Must file dunrg the fweNe (72) mo�s, �
before MarCh 31 0/ eacA year the ded�xtion is sought
Seereverseside7oraddifionalinsVUCtionsandqualifications, r acnn� �.. •�
npp(wnt (owner� oontrarl buye� - see restrrlwu m m,verse sde) •
� ra�e af re� {vopeny as w
alR11t yrX
It name M
Counry Audimr
County Recorder
I legal tlesaiptm R¢cortl mimbef Page mimEri
' -l�•Z. /-GY.Q �o� ``� -Oa
Mrtga9e / Contrari irdehted�ss unpaid as d Mortgage I Contracl'uWebietlness unpaiE a is Me appfrant Ure sde
Aamh 1, Kartent year date of aDpGp4m legal p equitable ovmeR
aJ 5�� ❑ Yes ❑ No
H owned with somewie other ihan spouse. i`drcate wuh whwn
rt�dipte bebw Is IM pmpeny in qurstion: MmWiy Azsused
Pmperl�' ❑AMWDYPssesscd
Nartre o� mortgagee ar crntraU se0er �'i��
c./
Address d mortgagee or mnbaa se0er (number and sveeR �y. sfa+e. arM ZIP code)
Name of assignee or other owner or hdEer of rtprt<
AtlCress ot assgnee (number end slreet �y. slafe,
Dces apptit2nt own yopeNy in any dher
munry in IMiana?
❑ Yes ❑ No
DeducUon apple4e.WTn�'ie a
20
Sigrawre d CounN nwitw
N
t of:
20 _
If yes, what couniy?
(_� COUNTY
�—'— _ �. ' � '
Dra�ver NO...p�� �`........
Card i�'O. :... �p.y3 �P
5l� t� .�Q' � W. O� IryNo
r�J —
20 � 20 _ � 20
Caunry
20 _
OaLL (rt+onfh, d3Y. y�a�
�
I I We cert'rfy urWer the penalry of perjury that Ne above and foregoing infortnalion is We and corte�Y and Nat the applipnt is a resident of IrWiana and
amer I contract buyer of the aforemenlioned property on date application is filed.
p+ature (owne�s luq remel; / J Date (monfi. day, Yea�
state, and Z/P cotle)
�U `� w
auttnr¢etl Ey aWy
W auNaaetl person (numbera�b slreeL dry, slaR, and LP mde)