HomeMy WebLinkAboutMortgage_Meade^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
:,-- :
; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R11 / 6-09)
�' 1 Prewibetl �y DepaRmeM of Laal GovemrtreM Frence
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�sTaucnoNS: T
�o be �led in person w by mail with the CountyAUditw o� Counry Recorder o! the county where the properry is teda F
Fifirg Dates: 7J Real Property Must file durrrn� the year (or which the deduction is soughL � Counry Auditor
2) Mo6de / Manufactured Homes rwt assessed as Real Property Must file dunrg the IweNe (12) month¢� O, / �' �
before March 31 of each year Ihe deducfion is soughL IV Y unty Recordu
See reverse side lar addrtional inshuctions alM qualificatbns. C
AppGCan� (orner umnvaa buyer- see restrn�lions on revarse sye)
n a , �-_ _ . ., . ., _ ,. ,�l �..,� ., _ �✓o i c
7aAng DistrkY ` � Key
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[.'r�, ;�r%��
It rartie m mmrE is dAFeren[ Nan ihat of aPP��. ��te 6ebw.
IJame d mortgagee or contrar� seller
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Address of fmtgagce w mntrad se0er (numbe� and strBef, cily. ^ . aM
Nama of assignee or other owner or hdder of mortgage
Atltlress of assignce (number aM stree4 �}: slste. an0 ZIP cade)
Dces aPpti�nt ovm property in any oNer If yas. whal munt�l
counrymintlana? ❑ Yes ❑ No
Deaumon approreA u� itre artaunt m:
20 _ 20
SignaMe ot CowN AuEi�w
e_
I/ We certify urWer Ue penal perjury ihat
owner I contracl buyer of ihe mentioned
,Signamre (o
7 ' ent applrant (numDer3� t �
K 7ti -.59n n�. Y���
-300-p03,Da -d/7
�ted�ress un0aitl az d Mongage / Contrac[ "cdeDlNm
dale of appfication
If awned vrith someone oNer than spouse.
WIHI Ta�g Oi51rif1?
COUNTYAUDROR
20 _ � 20 _
Counry
20 _
D -
s d Is Ihe appl'icant wk
legal w equi�ade wrtwYl
n Yes ❑ No
I5 the O�P�Y m Ou�tion: M�wwaP/ As5es5eE
❑ Real PmPeM Q Armually PssesSed
Moble Hane OC 6
Drawer NO... ���I........
���-d .io. ... 51 al�
daY. Y��)
e aM foregoing infortnalion is We and mrrect and �hat ihe apP���nt is a resideM o( Intliana aM
on date applicatlon is filed.
s67e, and LP mtl
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Pason a�Miorved Dy d�ly eaewted Powr! d Atfaney w by IC 61.1-12-0.7 I�� (�N,
Pddress of auUror¢ed pei"..a� (num0er arnd sneet rity. stale, aM ZIP ootle)