HomeMy WebLinkAboutMortgage_Davis (5)�^n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,_ • FOR DEDUCTION FROM ASSESSED VALUATION
� �• State Fortn 43709 (R17 / 6-09)
S i pry�ip�y py pePaR�M of Laxl Govemrtrent Fnance "
�"" File Mark
lSTRUCTIONS:
To 6e fiied in person w by mail wiN the CounryAuditof or Counry Recortier o7 the county where the poperty is located.
Filing Dates: 1) Real Pmperty: Must file during the }rear lor which the deducUon is sought. ��g� ,�-�b�_ VAuditor
2J Mo6i7e / Manulacluied Homes raf assessed as Real Property Must file dunng tAe Iwelve (72J months
6efore March 31 0/ each year the deduction is sought. e��
See 2verse side fofaddltronal inshuclions andqualilrcafions. GIBSO
qpp�p�� (mpn�r y pon(�C buyer- see re�i�s m myersp sile) (� `
� � � � i a U 1
Ases� rdue af �
A1art�h t, qaica yeer
rc�, wnai s ms � nw �� a�+�reua
nyre m fecad is Eitfemnt ihan ihat at applicant
ame of rtnrtgagee or crntract setler , �_
ciy, stafi.
Name ot assignee w oNer owner w ndaer m morcgage
ana suee4 �Y. �re, ana ur wae�
dirant wm property in any oNer I 1( yes.
Intliana? � . � .
20 _ � 20
d cac+a a,a�
20 _
06 � �T
rted�ress unpad as of Mwp
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_ -��
Recortl numbc Pa91 �
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unpaid as af Is Ne appfrcanl Me sole
@gal a equitaNe amM
❑ Yes ❑ No
d'rare wMi wMm
Is uie wocem �n a�w,: nnnuaM /�sessea
�o� � .....
Dra���cr N�•.........•.�
11 � �....
Card NO. ..... ..
lU � TU�
2� _ 2�
Counry
r ��
:ted m PmpertY
Yes ❑ No
Date (moNh. day, yea�
20
I I We certify under ihe penalry of perjury that the above and toregoing intortnatlon is true end correcl arM Nat Me applirant is a resideM of Irdiana ard
owner I conVact buyer of the afwementioned property on date application is filed.
..�,.�.� i.,....e.s✓�,o,.�,wr� bate (rtionth. daY.Yaa�)
FWlre�dentatltlreS�appGmnt numbra�stree�ary,stare. [�, r°°°e�`" �� /` n_ �� � � � �
v I% j S 1 v
Person auNOr¢sd Ey tluy ezecuteE Po.ver o(AtlomeY a M IC G7.1-12-0.7 �(�W. �Y
Pddren of auttroraed persm (number ard stree4 �1: �re. an0 LP code) .