HomeMy WebLinkAboutMortgage_Dowdy°•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
� : FOR DEDUCTION FROM ASSESSED VALUATION
�• State Fwm 43709 (R71 / 6-09)
�' � Prewibed by Departmenl of Lxal GavemmeM Fnarce
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wsrRUCnoNS: JA ° � "�010
To be �led in person w by mail wifh the CountyAUditor or Counry Recorder of the counry wl�ere the property is located.
FrNng Dates: i) Real Pmperty. Must file dunrnJ the year for which tha deduction is sought � Counry Auditor
2) Mobile / Manufactu2d Homes rat assessed as Real Property Must file dunng fhe fweMe (12) months r�
6efae March 31 of each year the deduclion a snught. �,7 unry Recorder
See 2verse side foradditional instructions and quali�cations. G�g
t(owrieracontraCbuyer-see mre sCe)
TaA istr'xY Key `wm6er / legal desaipUrn Record numbu Page wmbu
- _ 7- �o/ - 1I0.3.loo.3-Oot � 00 7 8
Asessed rdh�e d 2a1 p(aperty as N Ma�q age/ ContraG "uMehtedness unpaid as of Mortgage / Contract uMeMedness unpaid as ot Is ihe applirant Ne sale
Mard��1, amnt year Marr1� 1, artem year date af appGption legal w epuhade ame(.�
❑ Yes ❑ No
If no, what is his / Mr eraU share of internst? If rnmed wiM mmeorre ather than spouse, iMicate with whom
an remN is dAlaent Nan that
Name at rtKxtgagee ar contract se9er / 1 P��L �/
(.(J
ACdress W mon9a9ee ar mntraG se0er (nuriber end street �Rl: state. arN
Name of assignea w mher owner or hdder of matgage
Addrass ol assgnee (num0er aM stree; tlry. state, and Z/P catla)
di�N own property in any olher
Ineiaria? ❑ Yes
Dr�umon appmred in Ne amount of:
20 20 _
�nature W Countynuattor // �
//-�
./
I/ We ceNfy u er �he penalty of p
owner I mntraG buyer of Ne aforer
I u y�s. whec m�,nryl
No
COU
20 20
perty in Question: MnuaM A�seO
Property � Annually0.55essed
Moble Fbrne (IC 61.
0
— - Dra�ver NO:. �9.......
Tari�, " . /_/_ � X y
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Card NO.� ..................... �
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20 � 20
�d'�
ICounry I Dale (month. day. Yea�
Mat ihe above and foregoing infortnalion is We and corteU arM that Ne applicant is a resident of Indiana arW
ned property on date applicalion is filed.
Date (monCi. daY. Y�A
TGII RSident atlG�s d 2ppG4nt (numb(r and streef, tlly, s7ate, aM ZIP m[
cos �r��+nl�ee A�,N Pc',�cw�:�
Per.m auUnr¢td Dy 6Wy ezecutetl Paaer o(Attort�ey or Dy IC 67.1-12-0.7
Addresa at author'¢eed person (number arrtl sbae; cRy, state, and LP mtle)
o� �r�o�rcn. ear. r�n