HomeMy WebLinkAboutMortgage_Daly'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun w hi
___ � FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R71 / 6-09)
S B Presaibed M DeOanment of Lorvl Goremment Fnance
�«.
File
�iTRUCTIONS:
To be filed in person w by mail with the CountyAuditor or Counry Recorder of the county where the property is located. F� �����
Fitirg Dates: 7) Real PropeRy: Must fife during the }rear /or which the deducfion is soughL Counry A �
2) Mo6�7e / Manufactured Homes rrof assessed as Real Pioperty: Must file dunng the twelve (12) months GI N��R�� ITO
6efore March 37 of each year the deducfion is sought.
See reverse side for addrfional inshuctions and qualfications.
AooErarrtfowneWl'ca�badbuyer-seerextxeuns e) „
�se0 vehie Cf te� P�PeM1�/ as of
atdi 1, narent ymr
m, vfiat ¢ his / her ezaG share of interest?
reowd'a dR�t U�an Nat of appfrant
Name of mortgagee or rnntract
4:_u�:
tdder of morigage
�a�� � _ 0o<S` p��
3/ Coniraa iMehtednrss unpaid as of Mortgage I ContraC hWa
wrtent ye�r Aate of appOmlion �
azd s/2e4 �Y. sfate, arM LP Catle)
Ooes appluant own P�PenY in any otl�er
munry in Ind'aw? ❑ Yes
Drdumon
20 - � 20
d Can:b nwRttar
r ��
sorneo�re
Remrd num0er
as of Is the appOpnt Me sde
legal w epulbde own�t
❑ Yes ❑ No
wifh w1ro�n
property in VuesOOn: Mrn�aAy AssesseC
e21 ProPeRY ❑ �^!��Y �
What Teang D'atricl7 Nas 1ha d�diai Dee� requeste0 m propuly
��� ❑ Yes ❑ No
COUNTV AUDROR _ _ - - � - --
zo Aau,j, mgu R�.� E—
�,� l I - y�? 47 —
1 I We cert'rfy urder Ne penalry of perjury that Ne�above and foregoing infomiation is
owner / contracl buyer of the afweme`rtioned property on date application is filed.
/ sgrawre (ownrls fi� name)
`�� i�1.QA.t-iCG-- �[[3'.L�
FW �esidem atldas W appGont (numbe�andsLee; ary, state. ndLPOOtle)
� Gva .�• oAK s �xr �a�c� oX/ �iV 4���6 -ld /g
Psson autho�.W by dWy ezecuted Power of Attnrriey a by IC G7.7-12-0.7
of auNurzed per:.on (numberantl sbeeL dY. sb�e, andLPCnde)
3 ard
Date (montb. daY. Yea�