HomeMy WebLinkAboutMortgage_Chandler"`* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7o ear
__ • FOR DEDUCTION FROM ASSESSED VALUATION �
State Fortn 43709 (R71 / 6-W )
�' Preuri6ed by Departmenl of Loml Govemment Fuiance -
� File Mark
�NSrRUCnoNS: � � 2����
To be (led in person w 6y mail wdh the CountyAUditof or County Recorder of the county where the property is located. —��
FiHrg Dates: 7) Real Property: Must ke dunng the year for which the deduction is sought. � Cg q�ditp�
2) Mo6ile /Manufactu2d Homes rrot assessed as Real Property: Must file dunng the hvelve (12) months !t�
befwe March 31 of eadr year the deduction is sought. '� ��O e�d�
See 2versa side fo� addtionaf instrucfbns and qualifications. GIBSO
Apa� (ownerwaontrarl6uyar-seeresfir�unsmiewIrse� e)
�1.'1J� � „/ Oo,� �� � .( �.O�J Q . �
Key nxn6er
Y W /�� o�tG 1 r�(/ � T��/,/ ^
Asesud vaNe oF real property as of Mw(gage/ Contract indebted
Marrh i. armnt year MarU� 1, artem year� �
I
M ro. what is his / her exM share of intemst?
tt rwne on iemN's diRemnt Nan Ihat ot aPP�ni, md"uate Celow.
Name of rtrortgagee or
�u-'�.�.-''i-�
end sbae; ray, state, a� ZIP code)
owner rn hdder of mortgage
ACtlress of assignce (number ard stree4 M: �te, and ZIP cotlej
Dces a�innt own pmperty in any other
couNy in Indiana? r-i . _
oF
Zo � �
� w.� V. .W. �
I/ We certify under the nalty oi perjury
owner / contraGl buyer of �he aforeme�a
PerSOn
person (numDerarasbee4
�
_o af� o`j " lvS�
tgage I Cartvacl uWebtedness unpaid as d Is Ne aPW�t Me sole
: o( appGWtim legal w equit3de ownP.R
❑ Yes ❑ No
tl owned xith someone Wher ihan sGO�. iMrate with wtrom
� i`."�,�"`-�
Whal Tewry C
GOUNTYAUDROR
zo_
Caunry
�Is yIh�e property in QuesDOn: Mnualty Assesse0
e� ��� �PeKY ❑ Armually F�sse55ed
Pr/5
Has a dedixtim Deen reQuesteL on property
�W�� ❑ Yes ❑ No
x C �p�' ��/��i�LJ
— y �_J,
the above arW foregoing infortnation is We and �` l� lY ��
property on date applicatlOn is filed. �
stafe, aid ZlPOOde)
or by IC
�Y• Y�A