HomeMy WebLinkAboutMortgage_Asberry (8)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
; FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R11 / 6-09)
�' ,,,, f Presaibed by DeparbrieM ol LaW Govemme�n Fnarxe
INSTRUCTIONS: G n
To 6e filed in person a by mail wifh the CountyAudiror or Counry Recwder of the county where the pmperty is Ioc�tep8 p
Fitirg Dates: 7) Real Property: Must fJe dunrrg fhe }rear fw which the deduction is sought.
2) Mobae / Manufadured Fbmes not assessed as Real Properfy Must file dunng the nvelve (12J rr�ntlr3 �
before March 37 of each year the deduction is saqht.
See reverse side !or addiLOnal instrucGons and qual�cations_
Aoofrent fowne� a contraC buver - see msLirlims m reverse sidel
Counry Audilor
Counry Remrder
'JEtrict � KEyAumOer/IegaltlesaiDtion RecaNnumhrl Pa9enumbef
a6-ra_o7-Yo�- 003, as8-oa- aoio 5�a�
etl vahie d real yoperty as of Mortgage/ Contraa indehtedn�s unpaid as af Mortgage / Contrar] indeMedness unpeiE as d is Ne applircant Ma sole
1. arient year Mamh 1, airteM year Eate of aPP�� � or equitade v.vneR
�i� O�� ❑Yes ❑No
Rat is tris I her ezaG sl�ara ot inir�est? If mvned with someone dher than spouse. 4Mirate with whan
M
Address of rtart9a9ee w cmtraU se�er (number end sheef, ctiy. slare. aM ZIP oode)
Name at azsgnee w otirer owner
m slfeet �: stete, arttl [If' mtle)
any oNei If y�s, Miat munp?
Yes ❑ No
COUNTY
DeLuc�an aPW� m� amounc oE
20 _ � 20 _ � 20 � 20
s ProDertY in puestian: MtvaOy Assessed
Real Roperty ❑ AnnuallyAssessed
Mo60e Fimie (IC 6
'� _
Drawer \'0...... ��,0....
Car t
„�,T����� d �O. ..... C�-1
20 � 20 � 20
Sigr�awre d Counb Auditw I Counry I aate (rtmfn, oaY. Y��
G - T_
1/ We certify undu Ne penatly perjury that the abo and foregoing infortnalion is W e and cortec[ and that the applinnt is a resident of IrMiana arM
owner / contracl buyer of the aforementioned property on date appiication is filed.
Sigrenue (o�me hdl rmme) / Data (monfi. deY. YeaA
2vdent
PrJSOn authoraed
state,
person (num6ererM Sbee4 �Y. sb[B, erM LP mde)
Date (rtanN. EaY Y��