HomeMy WebLinkAboutMortgage_Smiddy (2)ry� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
� FOR DEDUCTION FROM ASSESSED VALUATION �1
_-- . � State Fartn 43709 (R71 / 6-09) 1 �
t' y„ � Presaibetl by Oepartment of Loral Gm�emmerLL Frence
ile Mark
„JSTRUCTIONS: f� f1
To6efiledin y ty ry lY P P�191�ated20�2 F�fl��:
person or b mail with the Coun Auditor or Coun Recorder o( the coun wheie the io
F7irg Dates: 1) Real Property: Must file durirn� the year for which the deductlon is sought � County Auditor
2J Mo6Ae / Manulacrored Hortres not assessed as Real Pmperty Must fife dunng the fweNe,(MJ r ❑
before March 31 0( each year the Ceduclion is sought. Counry Recorder
Seereverse ' ora "nalinstructionsandqualifications.� �,,,,,,.,,,,,,�,,,,r�,,,�Tno
�i110.Nildi
If name an
mmDer / leqal desmDtirn
a� i�-ia-a
poprl;y at W
h91E 011lIfPf25l?
than Nat of appGCan4
Name of rtrortgagee or contract sN�er �`(� ��
X�)
qddress o( matgagce w conbac� se�er (nur+�her eM rify, slate, aM
Narne M assignee or oUer owner or hdder of mort9a9e
AdOress ot assignee (number aM street, dry, state, s�W 7JP ootle)
Dces ePDirtant own property in any oNer I I( yes. what munty�
couny in IrW'ena? � Yes ❑ No /�.
_ ��(� �
peductionapyoved'm�heamouN'' /-� 1 � V
zo/�C(�Y��n� �l.��a
� � `�' �� �
I I We cer. �� � ;`� fon
owner/ca � I� � .FRyorW@Jea
�entatltlrei .,.acant(numberantlst(eetacity,slafe,andZlPm�
aob F: c�a��. s�.�,o��v:1i
Person auNOrized by duty executed Power al Aaon+ey or by IC 67.1-72-0.7
Atldress of autlia'nEd person (number aM15b2e1, city, s!d(e, aM ZIP codo)
Record u PaQe nymber_�
» s -v aa � � ���E-�,
'�9a9e / ConSaU indebteMess unPaid as d Is tt�e aPW'vant ihe sole
iate W aPP�� � w eWRade axmM
❑ Yes ❑ No
rith 50If1CWle OUICr CNn 5PD1152. i11dIW18 Wl(h WIIM11
�5 IhQ pfOpCfly Ifl QUCSOOfI: (UI(IU2� i'SSCSSL'd
❑ Real ProPeRY ❑ �^�Y �
Mohile Hame fIC 61.1-7
Wl�at Taring DisIriU7 I Has
for c
sted m propeity
Yes ❑ I
20 _ 20 _ 20 _ n1 _
Caun Date (monlh. daY Y��
ig infortnaGOn is true and corted aM �ha[ the applicant is a resident o( IrMiana aM
aUon is filed.
Date (monih, daY. YBa�
o� (�nm, aar. r�n