HomeMy WebLinkAboutMortgage_Malone^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ship ea
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: FOR DEDUCTION FROM ASSESSED VALUATION
� Sta[a Form 63709 (R71 / 609)
�,�,. PreunbeE �y DepartmerE a( Loral GovemmeM Firence
ie a
�VSTRUCTIONS:
k be (led in person or by mail with the CountyAUditor or Counry Recorder of the counry where Ne property is located.
Filirg Dates: 1J Real Property: Must file during Ne year for which Ihe deducfion is mught.
2) MobAe / Manufactured Homes rrot assessed as Real Property Must file dunrg the hvelve (72) months
6efore MarU 37 of each year the deductian is swght.
See reverse side (or additional insVUClions arM qualilmations.
App6cant{�vner w wryraa buyer - see restric8gp� m rev r�e stle)
Assessed vah�e URaYO�P�Y �W
Metdi 1. a+rem ymr
I( m, what is his / her e� share at interest?
name on rtmtl rs tlilfe�mt Nan
rlame ot �mnsavea «ca,vaa se��er
Pddress of mort9agee or contract sWer
Name of assignee w aher awner w holder d mortgage
stree4 �Y. sia�e.
s applinnt wm pmperty in a�ry oNer
Forq_"� Gl '
� Caun�r
GI SO�O����,���R
� -� l�/6 -D� Q -- - �_ �'6:
�. / Contraa'uWeCiednPSS unpaitl as U Alortgage I ContazY'vWeb[edness unpad as d Is �he app6rant Me sole
wrtem Y� dare of eG� � a��n
/%�� ❑ res ❑ No
If owned wiN sorneone dher tl�an spou5e, itMicete wM whom
hebw. Is e property in puestion: Mnua�y AuesuV
R� RoPeny ❑ am�any ws�ud
r.� rw�,e ic ��.�-,
uly. sbte. arM ZIP code)
� �AcO,� ,Z/-�eN-A�j /�
. % I r
whatcount�? IW�alTabrgDislnc
couNn nuortoR
20 20
Ha5 Na dedurfion Eeen repuesteE m prapeny
for we2nl yeaR
❑ Yes ❑ No
Pi�
�
I/ We cert'rfy under �he penalry o( pe�ury that Ne above anC foregoing infortnaUOn is We and cortect antl that the applinn[ is a resident of IMiana aM
ow�r ecFc9ntrad buyer of ihe�atoremerrtioned property on date aOP����n is filed.
jnat o /s MI ne e) � Date (nw�. daY• Yaeh
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ands�/C ��t. �aty, stat¢, dntl ZIP�CtO
1' 4�0 � 'v
' of Avoeney w by IC 6.142-0J
AdCRSS of 2uthM¢Pd pCSW� (numbe� alld Sb2et, Cify, stdfe, antl ZIP cotle)
�ate (nronfh. tlaY• Y��