HomeMy WebLinkAboutMortgage_Conley^�n STATEMENT OF MORTGAGE OR CON
_ : FOR DEDUCTION FROM ASSESSED V
� T. • Sfate Fortn 43709 (R71 / 6O9) �
�' �a. 1 P���� M�Pa�nt of Loral Govemmenl Frence
wsrnucnoNS:
To be (led in person w by mail with the CounryAUditor or Counry Reco
Ffing Dates: 1 J Real Property: Must file dunng the year /o` which the d
2) Mo6de / Manufadu2d Homes rrot assessed as Real P
6efore March 37 0( each year the deduction rs so1yht.
See reverse side for�dtlitiona/ instructions and qualifications. ,
�AppGfam (ow�er rt buyer- syg resficeqx(� m reverse side n n
i
] 2a1 P�`/ az
Y�
name on 2cotd is tlifterenl Nan
Name ot rt�utg2gce or
Mdress of mttga9� or canVad
TRACT INDEBTEDNESS Cou owns Y r
ALUATION
DE�Ce ��$ 200
rder oI the county where (Ae properry is located. F� �� ��l� �/
eduction is soughL pk,L,lag'Y+Liditor
raperly Must file d�ring Me tweNe (72) monfhs (/
GIBS N UtS'P1"'%Yl��
! legal desaipnErt
o-i�-�?/oa-
Aort9aBe / ContraG i'We6tednnss
AarU t. artent yryr
indipte bebw
wmer m hdtler of mortgage
rer aMl s1ree4 �Y. stafe. ana
Does epdira�rt v.vn yoperty in any ouier I �t yes. what munty.�
counry in Intlare? ❑ Yes
❑ No
�
someone other Ihan
lMialTeArg DistrvY?
unpeiA as of Is IM app8rant the sole
legal w ewitaNe oxneR
❑ Yes ❑ No
Is ihe property in Questirn: Mnualy 0.ssesse0
❑ Real Pmperty ❑ MnuallyPssessed
PAohile Hortie (IC 61.
Has Nis deEu�rn Eeen reQUested on pmprity
for artent yea/1
❑ Yes ❑ No
COUNTYAUDROR
Dr�uc6on appmved in ihe amount oF.
20 _ 20 20 _ 20 20 20 20 _
Sigreture N Cam1Y Auditw Counry Date (mon(h. tlaY Yea�)
I I We certify uMer the penalry o( perjury �hat ihe above and foregoing infortnaUon is We and corte<Y arM Nat the applicant is a resident of IrMiana and
owner I contract buyer of Ne a(orementioned property on date appiiption is filed.
Signawre (o /s !utl na Date (rtronM. daY, yea�
�
�FWI dent addfess N appfinnt n r aM street, ' e, ard Z1P e) [ �
O � � i % C�
Pason autlwRetl esecuted Power of Avomey w Oy IC 6t.7-t2-0.7 Oate (monN, day, yee�
RWEress of authomed persan (number aM sfreet ury, sb(e. anA LP mde) .