HomeMy WebLinkAboutMortgage_Anderson (4)^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
__ • FOR DEDUCTION FROM ASSESSED VALUATION
� � State Form 43709IR71 / 6-09)
�' prewip¢E py Departmenl of Lxal Govemment F�nce
��. I F,�
srRUCnoNS:
To be fAed in person w by maii vnN the CountyAuddw or Counry Recorder o( fhe counry where the property is � �
Filing Dafes: 7) Real PmpeM. Must file dunng the year for which Na deductlon is soughL � Counry Auditor
2) Mobde / Manulactured Homes not assessed as Real Pmperty Must file dunng tha nvelve (12) months MA 4�ZQ
belore Maah 31 0/ each year the deduction is sought. unry Recorder
See reverse side foraddiiional insVUCGons and qualrficetions. C.�.
App6onl(awrreror by+er-sea re siie) I
7arirg Distr� KeY � �k9�o �D � �O ' _ Remedy�mber Page iwmber
� O� (/�
p� �¢ y mai pmp¢Ry a y Mortga9e / Contra�x'vdebte�ness unpaid az of Mortgage I Cmtract i�Me6 ness unpaid as d Is Ne epplircant Me sole
MarM 1. ayma ypar March 1. a date of aOP�� kgal w epuitlde ownM
❑ Yes ❑ No
n ro. what's his I tcer ems share ot interest? It wmed wiN somew�e atliar ihan spouse. ifNicate wiCi vAwm
If name on recoN is Eirturnt tlian Nat o( aDP��4 mdinte belrnr. Is tlie ProPe„Y in question: MnuaM Pssessed
❑ Real ProPertY Q �; � 1.1-7
Name of �ronJa9ee or mntraG SeAer �/1
�J
Address of mwtga9ea or mnbact se�er (nurn6er and sLee4 �y. sdte, an ZIP code) '
Name of assignee w other owner or hdder of morga9e
AdEress of assiqnce (num6er aM slreet dry. state, antl ZIP code)
Does applrcant oxn pmperty in any oNer If yes, what munry? What Tad�g DisGicl9 F1as Nis tleduGia� been reQUested m prop�lY
counry in lndiana? far wrtenl Y�r � Ye5 ❑ No
� ❑ Yes ❑ No
COUNTYAUDROR
pydurflon approved h� Ne amount of.
20 20 20 _ 20 _ 20 _ 20 _ p_
Sigfuwre d Counb Autitor Caunry Date (rtmrh. daY. Nee�
1 I We certify under the penalry oi perjury Nat the above and foregoing intormalion is We and corteU arM Nat the applirant is a resident of Indiana arW
owner I uyer of tioned perty wi date appliqtion is filed.
SignaWre wrre 7W1 rtre) Date (mmtA daY• l��
F " e atld�ess of appGCant ber antl 4 dN. �te. aM ZIP catle) . _
ae,son auu�o�e Cr aWr �ea,tea Pa«er oranomev a M �c s-1.�n2-0.7 _ � Dace frtprrth, ezr, ree�
Pdtlress of autha'ved person (numberantl snee; clry. slate. anOZlPcode) . "_ _