HomeMy WebLinkAboutMortgage_Ravellette^�� STATEMENT OF MORTGAGE OR CONTRACT INDE��,S/ un Tovmship Year
. FOR DEDUCTION FROM ASSESSED VALUATION
:r-_.. • Staro frorm 43709 (Rt 7/ 6�09) A P R 19 2012
�` ,�� �� presrny¢E yy �epartmeM of L.onl GovemmeM Frence
C .'J.
File Mark
�INSTRUCTIONS: p��� ..
To be filed in person w by mai/ wiN fhe CounryAuditor or County Recortler of the county where the � located. �
Fil'mgDates: 1�RealProperty:MusttJeduringtheyearforwhichthededucliorGdB�..(ddt�t.COUNTYAUDITOR CounryAUdimr
2J Mo6de / Manu/actured Homes nof assessed as Real Property Must file dunrq the twelve (72) months � �unty Recorder
6efae MarGr 31 0/ each year the deduction is sougAt.
See reverse side /or addrtional insVUCGons and qualifiratbns. •
e...,rnmt.�r�rbmntra�buver-seereSMirlionsmRValba � e) /1 � ..
� p p� ' ' 1 Key mmber
rah�e rral popertY az ot !
Matl� 1, alma year �
ir �o. �� �s n� i ne� e� � or �n�ea�n
If riame an remd is dMeren� Nan Ihat ot a7P�^�.
Nartre ot nqrtgagee or mntrarl se4er
AdEress of mon9a9ee or wntraa seYer (num6e� a
� _ �-fX70 . S��bZU
Cebtetlrress unpaiE as of Mongage / Contract ude6tedi
uWuate bebw.
ci(y, state, aM ZIP code)
Name at assignee w other wmer ar halder of rt�ortga9e
AACren of asa9nee (numbe� eM aaee4 a1y. slate, and ZIP wde� -
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n�v.,..-. "_� ^M
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ao! .. ...
Dra���er�0••�.........• �o�
�7� a........
Card��• ....�3y1, ICO.a= zo
_ �
mmeone dher Ihan spouse,
��
Page
w epuftable owmeR
❑ Yes ❑ No
�s me v�cem �n a�: n��wauy wssessea
� Real FhoPertY ❑ M^!��Y ��?�
Whal Tadrg D'¢Vid7 I Has N¢ deduction Deen requeste
far euerent yeaR ❑ YE
\UDROR
_ 20 20 _
CounN ..--- � Date (rtanfh. daY.Y��
m pmperty
❑ No
zo
I I We certify under the penalty of perjury that the above aM toregoing infortnalion is W e and mrtect and that Ne applinnt �s a resident of InAiana aM
awner / contract buyer of the afivementioned property on date appfication is fiied.
. . . _ _ ... ____, i _ Date (nmtA, daY. Nea�)
ary, stafe, aM
bY
Atldress of euthuaed person (numDer aM sbee4 �: ��e, and ZIP mde)
Date (monlh.