HomeMy WebLinkAboutMortgage_Bryant (7)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
:.--..
� FOR DEDUCTION FROM ASSESSED VALUATION
• $late Fortn 43709 (R77 / G09)
S / presoipyE py Oepartment of Local Government Friance
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INSTRUCTIONS:
Fortn
To be filed in person w by mail wifh tAe CounryAuditor or Counry Recorde� of the county where the property is 1 ted.
Fil'mg Dates: 1J Real Property: Must !le during fhe year for which the deductlon is soughL Counry Audimr
2) Mobde / Manulactured Homes rrot assessed as Real Property Must fiie dunng the tweNe (12) months ,J� (I
befo2 Mamh 3f o/each year the deducfion is sotxPub. � U L l U--LO � L01nry Reoorder
See reverse side for addifional instructions and qualificafons. ��
a,�r����ew.wrarmrinacf -seeiesnicnou�smrerxrses�tlel .. • L . .•
M46sed vdhle d 2al Pm�;Y at of
MarU 1, aneirt year
Iq. W1181 LS hiSl h¢l ¢ZM� Sh818 Oi NiCfC51
It name m reco�d is d�Rerent Nan Iha� N ap
Name ot mortgagee « mntract se4er
Address of mortga9ee c� mnbaG sWer (nui
ryyne a1 assi9nee or olher owner w twlder �
AACress of assigrree (number eM snee4 �
Dces epplimnt ovm pmperty in any oUier
munry in InOena? � YES �
Deducfion appov�.•d'c� ihe amount oF.
— V
Mortgage / Contraa indebtetlness unF
March t.a� O
�,�, meinre Gelrnr.
ierandstreeCcdy,sfate.an Pmde)
mortgage
as ot I Mor�qa9e I ContrxY cMebtedness unpai0 as d
date o( appGmlion
tl owneE wiM someofre other than spause.
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ay9�......
20 � 20 � 20
AWitor
20 _ � 20
Caunry
p
;
Yes U No
Is ihe property in puestion: MnuaOy Assessetl
❑ itea� RoveAr ❑ nrmua�yassessed
Has I�is tletluffion been
r« a,rrem r�n
20
(rronth. daY. Y��
WWP+b
❑ No
20
I/ We certify urder Ne penalry of perjury that the above and foregdng infortnation is true and cortect arM that the applinn[ is a resident of Iridiana a`d
owner I wntract buyer oi the aforementioned properry on date application is filed.
Pason auNaraed
riry; s�ate, and Z/P cotle)
or by IC 61.142-0J
_ 'I Date (rtmfh,
P4tlre55 ot auttror'¢ed De�sa+ (numba� aid sLeeL dry, slale. ertl ZIP coCe) , ""