HomeMy WebLinkAboutMortgage_Ducharme^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ - FOR DEDUCTION FROM ASSESSED VALUATION ^
• Stata Fartn 43709 (R71 / 6O9J (� �
�,,,, Frewibea q DeD�rn ot Larai Govemment Firence /\
�� Fiie Mark
INSTRUCT70NS: \
T E� n rson b il w the CounryAUditor or Counry RecoNer o! the counry wheie the property is located. F� �� ���
Fdi at�s: Rea�i e. st file durirg the year for which Ne tleduction rs sought � Counry Auditor
� ctured Homes rrot assessed as Real Property: Must file dunng the fweNe (12J months
befornnM�a1r�ch 37 of each year Ne deduction is sought. ❑ Counry Remrder
See rever��'e �r adaSbAal instruclions arM puali�catrons. ��
MP��t (owner oroontrart �- see resuictons m reverse_sde) . �y .
C .'J.Me'-u
Ta�drg Distria K rwmCer/le destnp4
couN ��' —�j
Assess va4e af real papnny a o( Mwtga9e / Cont
MarU t, nrrrn[ yey Martli 1, wrteql
I �
It no, what is ttis / her eraft share W interesi?
I! name m remd p SMerent ihan Nat a( appGpnt. indicate Eebw:
Name ot rtuutgagee or mno-arl seDer �
Adtl2ss of mdtqaqce w wntract seller (numbe� aM svae4 cM. s1
Name of assignee or Wher rnmer or holder of mutgage
�`�• O�� w�/� Record number Page num6er
-�J '� n,_
/ (fJ
MeCteEfress unpaid a, of Mortgage 1 Con�aU'videMedness unpa' of Is Ihe applxanc the sde
date of appikation legal w equitade ame(.�
Og ❑ Yw ❑ No
If wmad wiN sameare aher ihan spouse. iMrate wiN wMrn
�s me vroaem fn a�esUm: a,nuaM.assessed
❑ Rea� Procenv ❑ o.m,ua�ywuessed
Rbble Fbrt�e IIC 67.b�
Address of assignee (number aM stree4 mY. �"-...•.>�o••wi .
�ucu�M�: s�c�y �
Dces epplimnt own property in any oNer �
munry in Ind'ana? r
❑ Yes � N�-�-,c;� D
DeCUUion approved in the amoum of:
20 20
Signawre af Counry AuCitor
I I We certify urWer Ne penalry of
owner I mgjf�aa buyer of tl�fon
� �—�7��
Has Nis tleEUdion Eeen repursteG m praperty
(OfWIIEl1�J23R n n
20 � 20
that the above and (oregoing intortnation is true and cortect arW Nat the applipnt is a resident o( IrMiana ard
M1�d property on date aOP���non is filed.
s Date (rtmfi. daY Yeeh
stata,
autho(aed by dWy ezewted Power W Attcrney or by IC 61.1-12-0.7
person (num0erantl.Weet. dry, slafe,
�ate (monN. tlaY. Yea�