HomeMy WebLinkAboutMortgage_Timberlake"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
_ y FOR DEDUCTION FROM ASSESSED VALUATION �
•S Stata Form 43709 (R71 / 6O9) �
�.�. � P�esrtibetl by DePanmeM of Loral Govemrtrent France
INSTRUCTIONS:
File Mark
To be filed in person w by mail with the CounryAUditor or Counry RecoNer of fhe county wAere the property i 1 � F i e
Filirg Dates: 1) Real Pmperty: Must file dunrrg Me year (or which the deduction is soughL � nry Audimr
2) Mobde / Manulaaured Homes not assessed as Real Pmperty: Must file dunng the twelve (1
6etore March 31 of each year the deduction is sought. Counry Recorder
See reverse side�r adtlitionaf instmctions arM qualficatans. MAY
- �
ns�esed vdue of real qaper;y az d Mrn
Ma�d� 7. arreN Y�N Mar
f ro. xfiat a h'a / her emY share of interest?
I( name m n,mrtl is d'Aferent t/han tha\t of appGCant, uie
1 \
Name of rtprtBa9ee contrat� Se➢er ./
Add� of nartgagce or
nearess
Inde6teE�ss unpaid as of Mpr(gage / G
+ Eate of applic
�t awned wftA someone
�/� . . n L
ntrxt seller (number3rd svee4 �1Y, sf�(p�J arrtl LP code)
ownerorfwlderMmorV C^ u. m L L W I�r �F�.E:�
Jtt
�` a011'�.�
� apptipn�' prop¢f(yinarryother
❑ Yes ❑ Nc
Dr�uaion approved in ihe amou�LL af:
�� 20 _ 20 _ 20
'� sigfance m Cawty aidifor
20 _ � 20
�
indehtednrss unDaid as af I Cs the aVdiwrt the sde
legal w equitade owne(+
❑ Yes ❑ No
han spouse. iMitste With whom
IS C�e DroGertY in Cuesfion: M(WeIIY hces5ed
❑ Real ProPeKY ❑ �!�N ���d
Has Na deduUion 6een reQUested an P�RY
rw �� y�n .
❑ Yes ❑ No
20 � 20
I I We certify under ihe penalry of perjury that the above and foregoing infortnalion is We and cortecl arM Uat the applicant is a resident of Indiana arM
owner I oontrad buyer ot the aforemerrtio�ed property on date application is filed.
Pov.x� aNtroiacd Dy dWy
oS auftwiaed Pers°" lnum6er
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street, dtY. state. and ZlPmde)
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