HomeMy WebLinkAboutMortgage_Dickerson (3)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__„ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 43709 (Ri t/ 6-09)
�' ,.,. � PresaiGetl by DeD��rtl af Laml Govemrtrerit Frerce
File Mark
�STRUCTIONS:
F
6e filed in person or 6y mail with the County Auditor or Counry Recorder o! fhe counry where the property is �.
Fi7irg Dates: 1) Real Pmperty: Must file durirg the yrear /or which ffie deduction is sought. {y d��p�
2) Mo6ile / Manufactu2d Homes rat assessed as Real PropeRy: Must file dunng the twefve (1 on
before March 37 0( each year the deduction is sought. [T p ecorder
See reverse side for additional insfructions arM quali�cations. ' CD
MP�nnf (owner 6y_�rse sitle) n . / � /� _ _ _ _ � n "" �.
oismti
� I1�I )- /� �./i /M �
etl ralue d rnal property as W Abrtaage / Contraa "udeEteOness unPaid as W Mongege I Convaa mEebteCness un7aid as of Is ihe aVd'�+t the sde
1. ttrt2n� Ypar Mamh 1, a�rtent year date o( aPP��^ �gal or eW flable awne(.�
`�j , ❑ Yes ❑ No
rtut is his f her euct share o( interest? � � If owned wiN wrt�eorre dher Man spouse, iMiqte wiN wMrn � CO 1,��I f
l
--.��"'".srJ
Name of rtnrt9agee or mnvact seller
Pdtlress W rtnrtgagee or mntraa seller (number aM stree4 ciry. s+ate. aM ZfP oode)
Name ot assiyiee or other owner w hdder of mortgage
(number arM sveef, tlry. stafe.
ryope�ty in any
h tM P�GertY in auestion: Mlwaly Assessed
� RCdI ProGertY ❑ ����Y��
hbWle F�brtie IIC 6
Has �his deduOion been re9uested m propelty
for wnert yean
❑ Yes ❑ No
COUNTYAUDROR
Deauction aPW� � � amount ot
20 20 20 20 20 _ 20 20
Signawm of Cowb Auditor Counry Date (rranth. daY. year)
I/ We certify under Ne penatty of perjury that the ahove anG foregoing informatlon is We and cortect and ihat the applinnt is a resideM of IrWiana aM
owner / contract b r of the mentioned property on date appliration is filed.
Sigrewre (ovm reme)� / Date (mw+N. daY. Y'��
Full 'dent of appliran number aM sbee4 mY, slafe. and ZIP mde)
Person auUroraed Gy duty executetl Porer o(AUaney or by IC 61.1-12-0.7 Date (month, day, yea�
/ddress of author'ved persori (number arM sbee; dy, stale, and LP oode)