HomeMy WebLinkAboutMortgage_Cline^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
s. --
� FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 43709 (R71 / 6-09)
�' ,.,. ° Presaibed by Departmen� of Local Govemment Flnance
Fiie Mark
�srRUCnoNS:
�o be (led in person or 6y mail with Ihe CountyAuditor or Counry Recorde� of the county where fhe property is located. �
Fifirg Dates: 7) Real Pmperty Must hfe d�rirg tha year /or which the deducfion is sought.
2J Mo6ile / ManuFactu/ed Homes rat assessed as Real Property Must file dunng the hveNe (72J monfhs
before Maich 31 of each year the deduction is sought �� o n Recorder
See reverse side for add"Rional inshucGOns and qualifrcations.
MP�.�4 (owne� w convaa bul'e� - see re§biceons on rererse sitle) ) ., _ . .� r�"`Tl' �_.
numCU / legal desCnption R�}i�
(o �oy- ab - yoo -OOO, s�o - o�o a� I
Mortgage / Contract iMebletlrress unpaid az of Mortgage / Contract "uWebtedness unpaid as of
Mard� 7, artent yrar Eate of appjication
It ra, what a ha / her er.act
witA sorneone CUrer Ihan spouse. iridkate with whom
If nane on remN is dMerent Nan Nat af appGrant, ifMirate Eebw
Name of mortgagee or mntrarl
ACdress o( rtwrtgagee w mniract se0er (nursiber and sbee( ciry. sfate. ard ZIP code)
mortgage
Ad�ress o( asagnee (number aM saee4 �1: s+are, and LP wde)
� Sr.J a-- �l 7. � 8 8/t �
Does appfiranl v+m p�ope�ty in any other If yes, what munp!M Whal Ta�dng Disinct?
counry in IMana?
❑ Yes ❑ No
Detluction approveC in ihe artaunt oE
20 20
Sig(at�ue of Cam Aud'
C '� ��sl���
I I We certify under Ne penalry of rjury that
owner / contracl 6uyer of the afwementioned
' �atu (axneYShN
� . . . - /_
GOUNTYAUDROR
20 20 20
❑ Yes ❑ No
IS Me ProOenY in QueSUOn: MnuaAY P55e5:xd
[�'I�eal RoPertY ❑ Mnualy Assessed
Dra���er NO.... -2 °l.l.-...
Card NO. ........�..?.� �..
hi���Ll
(rno�Yn.
aM foregoing in(ortnalion is We and cortect and that the applinn[ is a resident of Indiana and
i date appiicalion is filed. �
Date (manfi. daY. Mah
state, antl
Io
of Afim�ey w by
/dtlr�s of authorrzed person (number aid sbee4 �Y. sfate, aM Z!P cac�)
Date (monfh. tlay, ysa�