HomeMy WebLinkAboutMortgage_Brames"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS o nship Year
__ + FOR DEDUCTION FROM ASSESSED VALUATION
: . . ' Sfate Fortn 43709 (R71 / 6-09)
�' ,w. � Presaibetl Dy DepartmeM of Laxl Goremmenl Firence
wsrRUCnoNS: A�� p File Mark
To 6e filed in persan or by mail wiN fhe Cowry Auditor or Counry Recnrder of fhe counry where fhe poperty is located. �
Fi/ing Dafes: 7J Real Pioparty: Mus! file durirg the yearlor which Ne deduction is sought. � � Counry Auditnr
2) Mobde / Manufactured Homes not assessed as Real Pmperty Musf file dunng fhe M1velve �72) N�
6efo�e Mamh 31 o/each year the deduclion is sayht. OIBSON � Counry Recorder
COUN
See Ieverse side for additionel instructions and qualifications. -��
Appfiwnt(ownerormnvacl6uyeL,'seeres4'rlirnsmreve side)
District Keynumber/legaldesaiption '
-/l- -CYJ � -Cbi Fj
ed value d real property as d hbr�qage 1 Contrac[ indebcedness unpaid as d Mortgape / CormaG uMebv
1. asrent year Marti� 1, wrre t r ---' ^_�^ ^� =^^a'=�^^ . -
�'� ooc � R A m ES p�
11 no. what Is his / her euG share Of interesi? �
fwrie on rema b ailferent u�an
mnaaa senu
AAdrrss W rtnrc,7ageE or mntrad s�er (number and svaeL �1: s+a�.
Name o1 assgnee or aNa owner or halder d mortgage
PD�ress ot assig�e (number antl snee; rdy, slate, arM LP cade)
Annt wm property in eny oNer I If yes. what munp?
����� ❑ No
_ ❑ Yes
Deduction approvtd In tna amount oE
20 _
Sigiatl�re W CambAUditur
20 � 20 _
��'- 3a �3
IWtal Ta�drg Dis[nct7
)UNTY AUOITOR
20 20
Counry
iE as d Is ihe applkant the sole
- — legal or equitaNe o�mel/
❑ Yes ❑ No
�whom
estion: MnuaOy A�s¢sed
❑ /m,ua�N wss�s�
Has ihis dedurnm been re9uested m pmperty
ra cum.vn r�r. ❑ ves ❑ �
20
i.m
20
I I We certify under Ne penalry of perjury that the above aM foregoing in(ormalion is true and correct arW Nat the applirant is a resident of Indiana and
owner I contracl huyer of Ne afo2merrtioned property on date applinlion is filed.
inaWre fowne/s fu0namel � (�^�. daY.Y��)
x �������
Full residem address W appfrant
� "3. n ^� G 4 �
aemnn
Ct�
w ny
of auNa've0 persan (numberard s.ree; crty, state, aM
�LZ 1�l �
o� (rrb.nn, aay: r�A