HomeMy WebLinkAboutMortgage_Miskell"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
. . Stata Fortn 43709 (R71 / 6-09)
- �' � P�esaibed by DePartmen� ol Laal Govemrtrent Finance .
� File Mark
�INSTRUCTIONS:
To be filed in person w by maii with the Coun Auditw or Coun Recorder of the tain where the �'
N N h waaenr����
Fifig Dates: 7) Real P�operty Mus7 file durirg the year for which fhe deductlon is soughL Counry Auditnr
2J Mob�7e / ManuFaduied Homes rrot assessed as Real Property: Mus! fife dunng the fwefve (12J monNs'J.
be(ore March 31 of each year Ne deduction is sought. nry Recorder
See reverse side 7oradditional insWcUons arM qualificafions. CpUN
Appfwant(ownerorcontsctbuyer-seemsvicbonsrnrerersesitlel � _
X
Tav istrict Key numtffr/ legal desaiplion Recoid number Page num
Mp-�a-o9-30 _c�. _oa7 a��a yo�9
MaU 7, aarrm ymr �� h1ar� 9. aartent �intle6tedness unpaitl az W � g�age / Contrad'vdehtednrss unpaid as o( Is Ne aPP�t Ne sde
PP�� legal ar epuita6le oxn�
� � � (� Q ❑ Yes ❑ No
I( ro. what is his / her euG share of inteiestl If owned wiN someo� other than
. spasse, i�Wicate vAN whom
If name m 2md is Nflernnt ihan Iha� ot aPP�t uWifate Eelwr. Is iM P�GenY in quwtim: MnuaOy A.sessed
❑ Rea� Pfoaertv ❑ amuanyASSessed
Name ot rtnrtgagee or mntraa
��� a �va��
ownerornowerotrtqrtgage
,r asaqnee (numee� �a _so-eec dr. �?te
��/ T �i.) Y
li�nt rnm pmperty in any oNer
IMiana?
❑ Yes ❑ No
DeEuction approved in ihe artrount
ic.tp �. G
ciry, slate, arrd ZlP code)
� a -
If yes.
20 _ � 20 _ � 20
Sigianna
I/ We certify uMer ihe penalry ot perjury t the above
owner I contract buyer of the aforemen ' ed property o
�ire (owner's hN/�artre� n _ /1 � . .
mY
Addmss ot auC�w'ved person (numbera� sbae4 ury,
�
_'-"..�a��:: _.L=_
/ � �. � i g oc� °°
�
��T� Dra�}�er NO .............
_ �.a..
COUNTYAUDITC � � Tr�i�� �r I .••••••��•••••
U
20 _ � 20
3���s�l
�
0
infortnalion is we and correa and that the appii�ant is a resident of Indiana aM
ion is filed. .
Date (rmruh. da�:laa�
Date (monN, Eay, ysa�