HomeMy WebLinkAboutMortgage_Bennett (5)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTED�VESS Coun 7ownship Year
__,_ = FOR DEDUCTION FROM ASSESSED VALUATION p`b
� �• State Fortn 43709 (R71 / 609) � i
, �.�. Presaibetl Cy DePaM�nt o1 Lotal Govemment Fl�nte \
E� File Mark
�STRUCTIONS:
be filed in person or 6y mail with Um CounryAUditor or Counry Recade� o/the counry whe2 the property is located.
F�Ting Dates: 7) Real Properry: Must file dunig the year for which the deduclion is sought.
2) AbbAe / Manufactured Homes not essessed as Real Property: Must file dunng the hvelve (12J monMs
betore March 31 of exh year the deduclion is sought �
See 2verse side for additional �ructions and qualifications.
App6canl(ou+rerorcontrartbuy ' sb�DOnsmrev¢rsg "
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A/a�U t, orreni yrdr
�i M. W�IdI 6 �IR / h2f CIdU 5�12Ifl O( IIISCfPSi�
rwne on 2mtl a Eiflemn� Nan Nat af app6rant, uM'vate bebw:
or mntraU seller
.�' '�i=��Zll
Name W assi�ee or oUrer mmer or holder W mortgage
state, anC
P4tlress of assignce (number aM saee4 mY. slafe. and ZIP tode)
Ooes appluanl oxn pmperty in any oUer
wunry in Intlana?
❑ Yes
r� ���
If yes. whal munt/?
cou�
� �
unpaid as af
Whal Ta�drg Disvrct
F;�:
Fortn Ned wfih:
Counry Auditor
❑ Caunty Recorder
�� o �, 0 3 �-
WebteEness unpaiE as d Is Ne app&ant tlre stle
Ie�Jai or equita6le omre!!
� B D D ❑ Yes ❑ No
a spouse, iMicata whh wMm
is P�GQnYin7uesUm:MnuaDyASSe55etl
� afoaenv ❑ nnnua�qassessea
D�-�„��,-,o. a�. �.........
Card \�o. .....163�.......
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�°— � �°—
oa�e crtmm�. ear rea�
I I We certify under Ne penalty of perjury that Ihe above and foregoing infortnalion is We and correct ard that the applirant is a resident of Indiana and
owner I contract buyer of ihe aforementiw�ed pmperty on date appliration is filed.
I"ai'79lown�/s!W ).. _ � r . � Date(monlh�daY.Yeah
Power of Attomey w Ey IC 61.1-12-0.7
MEress d auNOr¢ed person (number and svee; c#y, sfafe, and ZIP code)