HomeMy WebLinkAboutMortgage_Daum"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
., —..
: FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Form 43709 (R11 / 6-W )
\ d Presvibed by Departmerit of Laal GovemrtreN Ftanca
�� File Mark
JSTRUCTIONS: �
!o be fiied in person w by mail with the CountyAUditor or Counry Recorder o/ the county wFiere the pioperty is lo�. � F� �
F�Ting Dates: i) Real PmpeRy: Must file durirg tha year (or which the deduclion is soughL �Coun Auditor
2J Mobi/e / Manulactured Hanes rat assessed as Real Property: Must file dunng the hvelve (12J months 1 ,�p�
6e(ore March 37 of each year the deducGOn is saght FE B 1�O I L nty Recorder
See 2verse side !ar addilional inshuctions arM ouawcafions.
Arnssed vaAc dreal yoprlty a d
MaRh t. armnt year
no, wnat z hs / her esafl share ot interest?
rvr^
Name o( rtqrt�agee or mnttact seller
Afldress o( mortgagee or mntracl ullu
� / k�y(a�l desaiplion/� 1 I
7 -llS�� /� 5�00�. / W�'�
hbrtpage / Contraa irNehteEt�s unGaid az ot Mortgage / Con:ract
Mart3� 7. airtent year date of appGfation
Name o( assignee w other owr•�rn.hdder of rt�ortgage
rJly. state. aM Z/P code)
�.�.,..,., �. o.,.�.,w �..��..��. ' _
U�'a»�cr i\'p,.. �' p
Ooes applimnt wm propem / / •
�,ay �� iwg�, � - .� f .
', Card �\�O. ....SSd (
DetluctlonaGW�'ed'u�ih . � ••••. ..
SC�'S, /d� . �
2� 20 ,
Sigrahtte U County AWiIn
unpaid as d I�I o�epuitade ox1M
❑ Yes ❑ No
H awnc� wiM sonwar�e ottwr C�an spouse. iMkate v.iU� whom
Is Me P�PenY in QuesUOn: MmiaM Asscssed
��� Real ancertv ❑ mm�,a�y 0.ssessed
Has Ihis deduUion 6een requeste0 m pmperty
for curtenc yeaR
❑ Yes ❑ No
OROR
20 _ 20
Caunry
Date (monN. OaY. Yea�
F;,;
I/ We certify under Ne penalry of perjury that Ne above and toregoing intomiation is W e and cortect a�M that ihe applicant is a resitlent of IrMiana aM
wmer�ntract buyer of the aforementioned property on date apqication is filed.
(own� rame) � Date (monM. eaY. Y�a�
crty, stare.
Date (rmnh. EaY. Y�h
of aultwr¢eC person (num0e� aM sbeeL c4y. stafe. eM LPt�otle)