HomeMy WebLinkAboutMortgage_Novotny,""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
. FOR DEDUCTION FROM ASSESSED VALUATION
State Farm 43709 (R70 /11-08)
��.a � PvewibeE bY �rN�ent d Lad GavemmeM Finanm ,.
tNSTRUCTIONS: Fle Mark
To be filed in pe(spi a by med witlr the CauntyAWitor d the county where the property is located. .I U L 2 Z 009
F7irg Dates: i) Real Property.� Must file dunng the yea� for which the deduction rs souqht.
2) Mo6de / Manulacfured Homes not assessed as Real Property: Must file dunng the tweNe (12) montAs befae March 310/ each year
the deductlon is sought. �Q� � �
See /everse side /or atMQanal ins6fiations arM auaYfications
7. nmenl yoa
ifiat is ha / ha e�ad share d i�rast?
a m re�vd is d�efeM ihan Ihat af aGGI
d mwtaaaee or mntracl se0er
6_�OOO.O� ^/� RearEnwypay�
R/ U 7�
ledness unpaid as d A/atgaga / nvaq indeble0ness unpaiO as of Is
/� dale of appfimtbn le{
V
B wmed with sort�eore dher Uvn cGase. ud'icate wiM whan
nderass d mortgaqea or oorrtrau seoer (mmxrane sbmt ah: stale, ano La code)
Name d assigfree or ofher ormer w hdder of mptgape
AAOrass
couMy in I�iare1
I—I Yes
tity, ffib,
Na
Yes ❑ No
Is NB D�RY in Ouestan: MnuaM Assassed
❑Real PropeAy Q MnualyASSessed
;tea an G�PaM
Yes ❑ No
COUNTYAUDROR
Dedurlion aPCmved in tl�e amount d:
20 20 20 _ 20 20 _ 2(1 _ 20
ura ' Aud'aw 1 Caunb Date I^�h daY. Y��
I/ We certi urbe� the alry o( perjury that e above aM foregoing information i e and owretl anE that the a�cant is a resiCent of Indiara and
owner I mn6ad buyer ihe aforementbn peAy on date appliratbn is filed.
Signatu /W rwne) Oate (�h. �Y. Y�1
� ras' address af aPdicant� aaM ciN, abM. ) 2/ /
/lf � O �-�i ( _%� �F W
Parsm autha¢ed by duy erewDed Power o(Atbmey w by IC 6-1.1-12-0.7 Date lmmfh. daY 1'ea�
Pdtlrass d aNhaized persan (num6r� an0 shcal, tiry, sfafo. an0 LP wEO)