HomeMy WebLinkAboutMortgage_Warren� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
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FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Form 43709 (R71 / 6-09)
�' Presaibed by DepartmeM of Loral GorernmeM Fuance
� File Mark
lNSTRUCTIONS:
with:
b 6e filed in person w by mail with (he Counry Avdimr or Counry RecoNer o/ the wunry where the properry is � .�
Filing Dates: 1) Real Property Must file durirg Ne year for whirh the deduction is sough[ ,_ � p,� ��
2) Mobde / Manufactumd Homes rat assessed as Real Property Must h7e dunrg fhe M�eNe (12) �tAsi� _�
befoie March 31 of each year ihe deduction is srought. er
Sea reverse side fa additional instruUions aM qualfications. J! �: �� ,. �
Appy�w,nl 4wrer ar confraC b r-s�(�es�s m�`C` rse 1 •
A I n fl A n,f� i 1�4�� \Y/1 M n�i' �0 I(1 A h n m C.1 m—�_ I
IMarM t. avmnl Year ( Me� 1. artey
,l
It ro. what a his / her exact share of interest?
U name m remrd'a dfierent Nan Nat o1 appl�n; uN'uafe 6elwr.
Name of mort9a9ee or mntraU sGler ��
Address of mort9agee or mntract seDer (number and sfreef, ciry, stete,
Name at asUgnea w ocher owner w fmlder ot mortgage
MCress o( assignee (number aM StreeS �y. slafe, arM ZIP cotle)
Oces eppircant own property in any other 11 yes. whal m
counry in Indena? �__ �__
]uc6on approuea u� me amoun[ oi
20 _ 20 _
funae af Co�mb AW itnr
I/ We certify u�er Ne penal of perju
oxm con buye of e e
1
� - rt address of avN�nllnumbBr and
o a of h�angage i contrart vWeOteeness unpaiE as 0� ' iiY�wBppY�nt me sde
Aate ot appGration legal w eWipde owneY.�
❑ Yes ❑ No
If owned with someo� other �han spouse. indimte wilh whom
Is in question: Mnua�y Assessed
I Property ❑ ,Nmualy assessed
Has iha eeauctim Deen requrstea m G��Y
for curren� yea(1
❑ Yes ❑ No
COUNTYAUDROR
20 20 _ 20 20 20 _
Counry Date (rmnth. tlaY• Y��)
the above arW foreg[�ing infortnaGon is W e and cortect a� Nat Ne applirant is a resideni of Irdiana antl
eg
property date applicalion is filed.
„ Date (rt�, EaY. Ysa�
Peison auNOr¢ed by dWy ezecuteG Povm.r af AtSOmeY a M IC 61. t-1
Address of aNhor'¢ed persM (numberaM SneeC tlty. sfafi, aM ZIP