HomeMy WebLinkAboutMortgage_Shaffer"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ _= FOR DEDUCTION FROM ASSESSED VALUATION
• Stale Fortn 43709 (R71 / 609)
�' r Presaibetl 7y Departmefn of Lo� Goremment Frence
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INSTRUCTIONS: A
To be filed in person w by mail with the CountyAuditor or Counry Recorder o/ the county whele the property is kcatedM,yY
Filin9 Dates: 1) Real Property Must file durirg the year for which the deduction is sought.
2) Mo6de /Manufactured Homes not assessed as Real Properry: Must fiie during Me twelve (12) mwrth�.� i
before March 31 of each year the deducfion is sought.
See reverse side for addi(ional insfructions and qualifications.
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If name m �emrd a NRernnt Nan ihat af a}
Name of mortgagee ar mntraU seller
Address o( rnort�agee w mntrad
Mdress ot assignee (number aM stree4 crty, <
Does apptifant own prapeny in any oMer
munry in IMana? �__ �
20 I 20
I/ We certify uMer �he penatty of perju�
ownr, r...,.,...,,. buyer of ihe afaremenli�
auu�aQee by auy
Adtlress
—tivy— vc� v � _
ContraG "vitle6te0ness unpaid as of
Remtd m
a.b-oaa.
Mort9age I ContraC'vWe6tedness �mpaid as
date o( aPP��
,.:�T'-�^• �1
Clem, Dassel�QTCo.
UIL.
•• Hvry. 165 8 68
P.O. Bex 459 • Posey�lle. IN a7633 �
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G
Counry Auditnr
County Recorder
Is Ne ep�nt the sde
legal w eWitade wvrel.+
n Yes ❑ No
ner Inan spouu. uWicate wrth wnom
��T�
i .'uty m 7uesUOn: MnuaDy A1sessM
(�?.vPertY ❑ArmualyPSSe.ssed
i MoWle Home (IC 61.
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� • � 812-8743627
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rera�dsveet ciry. sfate. andZlPcatle)
812-9&5-5619 812-422-9583
FAX 812-8743628
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s detlutlim Deen reVUestetl m CmpertY
� yean ❑ Yes ❑ N�
20 _ 20
Date (rtpnfh. daY Yee�)
�plicant is a resideni o( IrWiana and
Date (mor�fh. daY. Y��
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