HomeMy WebLinkAboutMortgage_Alldredge (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
� � State Fortn 43709 (R71 / 6 W)
� Presaibed hy Oepartmen[ of LaW Govemment Fna�xa
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INSTRUC110NS: F
To be filed in person o� by mail wifh the CounryAuditw or Counry Recorder of the county where the property is located. Fwm med wttn:
Fi/irg Dafes: i) Real Property: Must file dunng the yearfor which the deduclion is wughf. �� �y�����
2) Mo6de /Manufactured Homes rrot assessed as Real Properry: Must Tile dunng Me tweNe (12) months R
befoie Maich 37 0/ each year the deducfion is sought. 211. ('FA���
See ieverse qualdicafions. �\\
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n3$esse0 vdhre d m�l popeny az w
Mard� 7. aumnt }m
I( no, what is his / her exact share of interesl?
If name on 2cptl is EiRemrt Nan
;16� (Od —
rtna4e / Contraa indeht
rrotgapee «mntraU se4er Q (
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of mortga9ce w mntract seAer (num6er aM stree4 �y, sta+e. an0
Nam¢ 0/ assignee or other avmer w hdder of mortgage
Adtl2ss of assignee (number antl stree4 my. state, antl ZIP code)
Oces appli(snt wm yoperty
zo
approvea m Ne amounc m:
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unpaid as o( Mortgage 1 Contract'uqebtedness unpaid as of Is Ne appliont Ure sole
date o( apP�� k9al or equitade ameR
❑ Yes ❑ No
If owned with someone other than spouse. mdinte wiN wimm
Dra�ver NO.. �1.� ......
Card \�o. ...3�a5.......
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Is Me ProGP+�Y in question: Mnually Assesse0
❑ Real Pmperty ❑ Nmuaily Pssessed
duUbn been re9uested on P�Y
�r ❑ ves ❑ No
za _ i Zo
,�n,re a coimb a,eitor � I , I oate (monm. dar, r�n
1 I We certity unAer Ne penalty of perjury that the above and foregoing informalion is We and cortec[ arW Nat the applicant is a resident of IrWiana a�M
owner! wn buyer of �he aforemerttloned property on date applicatlon is filed.
��Wr! (own fs reme) /''.sA /, / . Date (month. daY.Yea�
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Person aultwfized by duh/ executetl Powr!
ce�
state, aM Fl�ode) .
ney w by IC G7.1-12-0.7
tity, Slate. end LP Gnde)