HomeMy WebLinkAboutMortgage_Dix"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
_ : FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709 (R71 / 6-09)
, Presaibetl by Depelbnenl of Lotal Govemmenl Fnence
File Mark
INSTRUCTIONS:
To 6e filed in person or by mail with the CountyAudifa or Counry Recorder o7 fhe counry where fhe property is bcated. F ���
Filirg Dates: 1) Real Property: Must file dunrn� fhe year for which Ne detluction is sought �� ��
2) Mobde / Manufactu2d Homes not asseued as Real Property.� Must file danng the Avelve (12) months
betwe March 37 ot each year the deduUion is soughL ❑ Counry Recorder
n
See 2verse side 7or addifional instlucdons end qual"fiicaf6onS —' "'
nppGCam ( t m�r�"rt 6uyzr. see re�nicrions m re�e siy . . 1
ds�ssed ra4re d maI qopercy as
MBiW 1, arren[ year
�� Iq. W�lai 6 �16 � hPlOYM� :1Nf8 Oi Yf{PlPSI�
remN e Eifterent ihan ihat o( appOran; uitl'uate 6ebw
mntrarl se0er
2-- o�- ( c�-bo3. �a�-oaB ��a�a�U lTY�I�
: irde6teOness unpaid as of Mongage / ConYart "uWehtedness unpaiE as d Is fie eppOmni Me sde
date o( appGtalim legal or equilade ame/i
❑ Yes ❑ No
tf a+med wiM someo're athu than spouse. Ind'�ta wfth whom
o� mntratl seller (number and street, tity, 57sfe.
w ather ovmer w holder M mort9age
AGtlress o1 assignee (numDer e� slree4 �Ry, s1Ete, and ZIP catleJ _
Does appliont own poperty in any oNer
mu'rty in IMana? � . _
aa�S......
Dra���er ��•.......
CaCd��• ...•���
� \'����P�'6�
zo � 20 , �u � zo _
I/ We certity urlder Ue pe
owner I mntraU buyer�of th
Sip re
ull rev nc etltlress o( appfinnt (ni
t� �63 W�s'F- :
Pason autho�d Ey dWy exewted
AdCress o(auUrortreE persan (num.
Counry
Is the property in purstion: MnuaOy Assessed
❑ Real PfoPertY ❑ NmualyAssessed
eno�� r�o� nc ��.
i�95 U16 d2d�ldpfl �BEI12QU25iEli M pfOpM`/
tor arrent YraR � Yes ❑
zo I zo
above and (oregoing infortnalion is true and cortec[ and Nat Ne applinnt is a resident of IrWiana aM
>erry on date appiication is filed.
Date (rnonfh. daY. Y��)
riry, slafa, and
of Atmrney
slate,
C � �7�
Date (mrN. day �