HomeMy WebLinkAboutMortgage_Jackson (6)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ , FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R71 / 6-09)
�' , P�esaibetl by �epartrtrent at Laal Gwemment Fnance
��w File Mark
NSTRUCTIONS:
o ttt��� wnh:
To 6e filed in person or by mail with the CountyAuditor or Counry Recorder of the tounty where the property is located. ���
Fil"mg Dates: 1) Real P/operty: Must file dunrg the year Por which the deduction is sought. q i�
2) Mobde / Manufactu2d Homes rrot assessed as Real Property: Must file dunng fhe fwelve (12) months
betae Ma�ch 31 of each year the deduction is sought �
See 2verse side /or additional instmcfions arM qualfications
Appf t(owneracontra uyer'seergstrictionsm2�rses" 1 �
o�-a�r-- �-�• c.�.
Ta "ng Di n Key numbu! Iegal desri G� rti numCU�v P3be num6u �D
a� -/8--��- 5�0 -ooa. a a5-o a � N `�
value d rnal property at d Mortgage / Cqntract irMebtetlness unpaid az of Mortgage / Contract i�Webtedness unpaiE as of is Ihe ap �e sole
Mardi 1, nma¢ yrar Martl� 1, wrtent year date of appGration legal w equilade oxneR
❑ Yes ❑ No
It no, what is ha / her exarl sha�e of interesi? If owned witn mmeone other ihan spouse, iMirate wRh whom
nameon
Name M rtron9agee w mntract se�ler
AOdress of rrortgagce a contratl seller (number eM
rvame m assgnee w omer ovmer
L J'j�.�
own prope�ty in any other
'W?
❑ Yes
Dr�ucem approved'vi 1he amount oE
state,
No
6eb�r
ci(y� sfate�� �P cOde)
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!. U fi- L
s, what wuntyt
wnat iaprg uama!
COUNTYAUDROft
Is the pmperry in Questia�: MnuaDy Assesse0
❑ Real Roperty ❑ amua�y Assessed
� MoWle Fiane (IC 6
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p,-a,��cr tio. a.,.:.,,
'3980 ....
C,�i.� \Q . ..:..........•� ,
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IYO I
20 20 20 20 20 20 20
7�qnne W Counry iwr Counry Date (montlti eaY. Y��
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I/ We ceNfy under the penal perjury Nat above arW foregoing infwmation is We and cortect and that the applirant is a resident of Indiana and
owner / mntrad buyer of the a mentioneG properry on date application is filed.
3 (o e/s hdl reme) Date (rronlh. daY. YBaA
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�le�n"1 �.✓a IC�(L�e� S��r�YPL/Y0.1\G^ i l JV -L !p"G�
Pe�wn authoraed by dWy exewtetl Power of Anomey rn by IC G7.1-12-0.7 � I Date (monfl+, daY. Y��
Pddress o( authoraed persm (number arrtl stree; ciry, sta(e, and LP mde) .