HomeMy WebLinkAboutMortgage_Bradshaw (2)_"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ � FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 43709 (R71 / 609)
� � PresC�bed �y Departr�renl of LDfal GOVemmenl FinenCe
INSTRUCT70NS: �
To be lled in person w by mail with the CounryAuditor or Counry Recorder o/ the wunty where fhe property is located.
Filirg Dates: 1J Real Pmperty: Mus! file durirg the }rearlor which Ihe deducfion is soughl.
2) Mobile / Manulactuied Homes rrot assessed as Real Pmperty Must fi/e dunng fhe hvelve (72) months
6efae March 37 ot each year the deduction is sought.
See reversa side for additmnal instnxGons and qualifications. ,,,�„
D`�a �C/(l rn I Key�1e9a1dEsqiGyoP �^�O�{ �`r -– •� o y �a� � Recoid g�
d/��. 41
zC �a4s cf real�— Monp age / Conbaa mCebtednPSS unpaid as af Mortgage / Contraa uWebtedness unpad az
i. armnt year I March J,yyrest year,_�� �ate of aOpGCation
If rw. what is lus I lcer exaa share Ot Nteresi?
If �ume an r¢mrd's E'iftPlEnl Nan Nai OI aDp9ranl hMifate belOw.
Name ot rtwrtpagee «contracl se0u
aM ZIP codej
If owned wi� someone other Man spouse,
PdCress ot assig�e (number eM snee; ary. s(afe, and L /y�"
D1"a11'C'1' 1�`0..�..1........
Dces appi'uant am property in any oNU If
munry in Intlana?
❑ ves ❑ No C:I I'(1 l�r�. ..... .1.� .I........
�uction approveA in the amount oF.
20 20
Sy�tl�re W CauiH Auditor
I/ We rtify under Ne penatty of perjury that Ihe above
o r/ contracY buyer of the afaeme`rtiy�ed property o
mre A nm^a:1e> _ /� .
� gl, a-�,Y�
Atforney w Oy IC 61.1-12-0.7
per�..on (num0er arM sbee; ciry. ffite.
Caunry
Auditor
Recorder
1'[=�7���E]
Is tice properry in QuesGOn: MnuaDy AsesseC
❑ Real Pmperly ❑ Nmually 0.ssessed
Mobile Fiome fIC Gt.
s mis deauaim oee� reQUested a, propeny
wrreM yean � Yes ❑ I
Z(1
20
infortna�on is We and cortecl and Nat the applirant is a resident of Irxliana arW
ion is filed. -
oac� c,�m. ear. reed
�r. r�d