HomeMy WebLinkAboutMortgage_Priestn STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 43709 (R11 / 609)
,,,,, ! Preuribetl by DePa���n of Lnd Government Firence
File Mark
�VSTRUCTIONS:
To 6e lled in person or by mad wdh the CountyAudiror or Counry RecoNer of fhe oounty where the popeRy is bc� �-� fi
RNrg Dates: 1J Real Property. Must fiie dunig Ne year for which the deducfion is sought. un Auditor
2) Mob�7e / Manufactured Hanes nof assessed as Real Property: Mus! fife dunng the twelve (12J months unty Recorder
before Ma�ch 31 of each year the deduction is sought. S E 4�0�
See revers side /or additiona/ instructlons and qualifications.
Aodira r orconfraU buyer- see (eslnilions revzrse side) • �..,. �.e.,�,�y
� ' _ '~—
description
'- �S-/a/-000. 3��_ o„�o
�e/ Contracf intlrbtedncss unP� as o( Mort9a9e / Conrac
I, artent year date of appfifatian
her e� 1�are of infrlest?
If rwne on �ecorC is diflerent Nan Mat of app6ran4 ���e Gelovl
Name af martgagee
martgagce or contract
w other o�mer or imlder of mortgage
c��n
AdC255 0( auignee (number aM slree4 �'. s�ete, end ZIP coEe)
If wm0tl vrt�
Doe� aPpliranl oxn property in any oNer I If yes, what wuny.+ I YMat Tadng
counryinlntliana? n ., n ..
GZ�]
3iY+ature
20 � 20 � 2�
I/ We certify under the penalry(�f perjury e above and foregoing infortnalion is We
owner I contraci buyer of the aforemenUon �operry on date applicaeon is filed.
� SignaWre(oxner'sfiNname) �
FW rrsiEeni add�ess of appGCant number end sbee4 �Y, sfzle, nd LP oode
,� � m I t, �-
Pelson auNOiaetl d�Ay ezecutetl Power of Atlamey w by IC 61.1-12-0.7
Address ot auNa¢etl persrn (num�erarm s�ee; pry, state,
Is Ne appaant Ne sde
�gal w equitade wmM
❑ Yes ❑ No
'u�dicate wiCi wfwm
I5 Ihe Pmperty in Question: MnuaOy Assessed
�eal F'roPertY ❑ MnualiyAssessed
1 � - y3��
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