HomeMy WebLinkAboutMortgage_Beal""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun 7ownship Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
Sfata Fortn 43709 (R71 / 6-09)
� � Presaibetl q' Departmerd of Lod Govemment Fuiance
ile Ma
INSTRUCTIONS: �Y
To be fiied in person or by mad with Ure CounryAuditor or Counry RecoNer o/ fhe munty where the propeRy is loca '
Ffig Dates: 7) Real Property: Mus! fite dunng Ne year (or which fhe deducLOn is soughL � Counry Auditor
2) Mobde / Manulacturad Homes not assessed as Real Property: Must file dudng fhe tweNe (12) mo q
befae Malch 31 of each year Ne deduclion is sou�ht. � �v �+�lY Recorder
Seereversesidefnradditionalinstnxtionsandqualifications. t318$ON COUNTY AUDITOR
Appfrant (qp�er orcont2C buyer'seqigsLictians m reverse sidej
�J�Ll�l� i 'i ls' Z=
0.�essed rehie d real WaP�Y as d A7ortpage / Contr�
MaC� 1. amnt yrar MaRh t, ar�nr�
1 ��
;i m. what is his I trer ezad share ot interest?
H name m remtl's QAterem Nan ihat U aDP��t InOipte bebw.
L;,�n^ z�T.'�.. ,�
w othrJ wmer a hdder of mMgaga
�:
AddRSS of assi,p�ee (number end saeet �Y• sbte. anALP code)
Ooes epplilznt ovm pmperty in any oNer
muMy m Ind"ana7 I"1 .,_ _
20
SigriaMa ot Camy Audilar
`4�.
' VU IJ�O �e•.� v
1 as d Mongage I Con� mCehtednrss unpaid as d Is Ne app&�ant the sole
EaU o( appGtatim _ legal or eQUitaWe oxnerl
f�2�ves ❑ No
�t ovn,m rAm someone od�u wn spouse. ir�rate wim whom �
Is the property in QuWipc Mnually Asse55e0
�ea� PmpenY � Annualh' Assessed . . _
I( yes. what countyt � What Tad�g D'e
20 � 2� � 20
GR� QEA[�
M � µ��
�� /d/O
p— � p—
�8i8 �IIM�Ir ddy %'Ha/�
i/ We certify urWer the penalry of perjury ihat Ne above antl foregoing infortnalirn is We and cortec[ arW that the appiirant is a resident of Indiana and
owner / contrad buyer of the aforementioned property on date applin4on is filed.
^J
' Y/l.l�
by IC 61.142-0J
Pddre53 of auUiomEd person (numberaM Sbeet �}: slale, arM Z!P mtle)
Date (monN. daY.