HomeMy WebLinkAboutMortgage_Adler^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
__ , FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 93709 (R71 / 6-09)
� E PresaibeE Ey DePa�ril d Loml Govemment Fuance
INSTRUCTIONS: � �
To 6e filed in person w 6y mail with the CountyAuditor or Counry Recorder oI Ne counry where the property is�
Filirg Dates: 1) Real Property: Mus! file dunng fhe }rear for whicA fhe deduction is sought.
2) Mo6ile / Manulacturcd Homes nof assessed as Real Property: Must file dunng the hvelve (72)
before March 37 of each year the deduction is sought�
See reversa side !or additional instructions end qualificatians.
I MOUOB�Lt6�me� or tonfraC buverw m twerse sitleYl
nm.wnatansi
II �n�e m �eco�d
- / 01- 4 l -o<
�Be / Contran intleCteCn�s
6�dicate
Wme M mortgagee or�+ seller
�/A�Y/ � L/�� �
Address of nnrtgaqee w wntrad srder (num6er and sLee; cCY. state, arN �
Name al assignee or oNer owner or hdder ot morigage
AdCress ot assignee (number arM street �1: sta:e. and LP tade)
Does e�mnt wm property in any oNer If yes, what count�?
munty in Ind"au? ❑ Y25 ❑ No
approveC in Me
20 � 20 _ � 20
20
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E
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w
Auditnr
Recorder
°� Si� ��es U No
spouse, iMimtc with m
Is O�Y in question: MnuaM AssesseE
[�I ProPertY ❑ %vmuallYA�55ed
0.lodle Fbrtie (IC Crt.1-i
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DC:I\VCC \�........
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Signawre W Counb/wditw I CaumY I Date (nwnHi. daY.Y��
I/ We certiy urWer the penaly of perjury Nat the above and foregning intortnation is We and cortect arM tha[ the applirant is a resident o( Indiana arW
amer I mntract buyer of the aforemerrti ned property on date applicatlon is filed.
s�wan,re �awr,en r,m rert,ef � n /. oate (rt�. mr. r��)
Pelsm autMtaed Ey Eury execvted Pw/er of AlfameY a bY IC G7.1-12-0.7 / I oa�e (monm, eer.
Mdress W a�MO�sseO person (number aritl sbeet, dry, sble, aM LP code) .