HomeMy WebLinkAboutMortgage_Heath'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
:._—
; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fwm 63709 (R71 / 6-09)
� w. J Presaibe0 Ey Departmertl of Locai Govemrtrerrt Frenca .
INSTRUCTIONS: r R�y�M
To 6e lled in person or by mail with the CounryAUdRw or Counry Recorder o1 Ne oounty where the property is located� U L J� L U � I�:
F�7ing Dates: 7) Real Pmperty: Mus7 file during the year fw which Ne deducfbn is soughL Coun Auditor
2J Mo6de / Manufactured Homes rat assessed as Real Pruperty: Must fJe dunng the twelve (72J month ry
before March 37 0! each year 1he deduction is soughi. �"�' ounty Recorder
See reverse side for addiLOnal insvuctnons arM qualifications.
Aoobo4dt (owx� or contraC b�a�er- see reshic8ons on reverse sidel
� Keyrumber/'I/egaldesoiPUOn 9
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,. artren� M�B�e
89. o o � �����
ro. wltat S Ns I M1er e�
urtl number Page numbu
ii a o
3id a d Is Ne eCP�t ttre sde
�a���
❑ Yes ❑ No
If owricC wiN someo�re oNer Ihan spouse. iMicate with wham
I( rwne on remd "a A'ifFerent than ihai o/ aPP��t'uMit�ate Dekw.
Name M rtaRgagee a mnttact sellerV'%�^A`� �' ^' '"'
Address of mwtgagee w cantract seller (number stree( ciry, state, aM ZIP code)
W
mortgage
-_,
�oes eppliCaM orm property in any other If yes. what counp?
munry in Indana?
❑ Yes ❑ No
Or�u�Yipn apywed in Ihe artpuM of:
20 � 20 _ I 20
SignaWR W
I/ We certify under ihe penalry of pefjury that Ne
owner / contraU buyer of the aforementioned pro
dN,
rr�ri,^
Is pie property in purstion: MnuaOy AsesseE
❑ Real PropeAy ❑ ArmuailyPSSesSed
N��� ���N T
o��p , I�-��90
COUNTYAUDROR
20 _ � ZO _
Caunty
r.1� ��
Dare innNh, tlaY. Y��)
20
€ arW (oregoing infwmation is We and cortecl arW that the appiicant is a resident of IrWiana and
on date appliration is filed.
Da[e (nmfh. daY. Y��)
Adete55 of auNUrzed person (numberarM 51n:eL tily. 5tate, and ZIP oode)