HomeMy WebLinkAboutMortgage_Shoultz (4)"•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
� Spte Fwm 43709 (Rt i/ 609)
�' r Presrribed by DepartmeN ol Loml Govemmerd Fuunce
� F'
INSTRUCTIONS: �
To 6e filed in person a by mail with the CountyAuditor or Counry RecoNer ol Ne county where the property is ted� F�
Fil'mg Da[es: 7) Real Pmperry: Must file dunng the year fo� which the deduction is sought Coun Auditw
2) Mo6de / Manufactumd Homes nof assessed as Real Prnperty Musf file dunng the lwelve (12) months
betore,uaicn s� o�eacn yearme deducrion is souyht JUL 2���unry Recorder
See reverse side 7or additional insWCtions and a rca�ns. �� .
AppGcant (ownei or confrdC 6uyxr - see restr'rliorss ' e) _ � ^ %Il � v
f��r
If im, what is his / her exad share of interest?
tt name m rem�tl's �frJmt ihan Nat of app6rant, uMirate Debw
mongagee «mnvaa
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Name ol assignee w dher owner or hdder of mortgaga
(number end sbee; dry, state, antl LP tode)
Dces e�icant ovm propMy in any oNer
munry in Ind'ana? r—� ..
�
I/ We certrfy urder the
owner I mntraG buyer
�
i— 0 �— � '�
4de6tetlness unpaid a ot Mor1
v _ date
tt owned with somew�e other ihan spw-"
Ta�d'g DistriC�
d I.IS P�, gPpirant Ne sde
/ r equifade ame/!
� Yes ❑ No
c� �
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� DI':l\1'CI" \�...�X`.�.:•....
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$ C�3 atio.
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e55ed
nc ��.
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Ne above and forei � .._- -._ ..�nam �s a resident of Indiana arW
property on date ap�.��.,awn is mea. .
Date (monR�, daY Yme�
sta[e,
Person autlaRed Dy Euty execyretl PoWer of Attomey m by
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Date