HomeMy WebLinkAboutMortgage_Dyer (4)�pSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u T n hi Year
FOR DEDUCTION FROM ASSESSED VALUATION
:• State Fwm 43709 (R71 / 6-09)
,' PresviEetl Oy DepartrneM of LoW Govemrtrent Fuance
"" kr( Q F�ile� t�
wsrRUCnoNS:
b 6e filed in person or by mad with the CountyAUditw or Counry Recorder o/ Ne counry where the properry is located.�:-�. F� �� ��
Filmg Dates: 1) Real Property: Must file dunrg the year lor which fhe deduclion is soughG !i'/o County Auditor
2) Mo6�7e / ManufactureU Homes not assessed az Real Properry: klust file dunng tAe twelve (7 nths
�i�pN .� OCaunry Remrder
6efore March 37 o/eadr year Ne deduclion is so�ghL COU
See reversa side !or additional instructbns and qualifirations.
IMP��t(mmeiarcontraUb -see ^ onlawrseside) � _
sesseEvahcdrealqopertyasd Rbrtpag e/CCCaaaq��j
mr3i 1. aricrt year M3rt� 1, W�
Ib, WhBI IS hi5/ h¢f 2IDd ShefB Oi 1(118RSS7
f WIIB Ofl f96Md 6 QA�2lP111 thdll Uldt Oi 2VP�b. Cldlpi8 GC�OK.
Na� or �ay� a
mytgagee or mntraq se�er (nunbar ard snee4 �ly. slate.
signee or ahel awner m hdder of mortga9e
adeeS �l: ffife, and ZIP cade)
Does e�i�nt own propeM1y in any oMer
�„� � I�a�? ❑ Y� I
Detluceon approved in ihe amount at
20 _ 2(1 _
Sig - � AWknr
I/ e ce uMer N natty of p
owner I con ct buye f the aforer�
�Sig/���p�re o 7u11name)
�L / 1 I �./l \
�
� aoa�ol.48a � �� 010 P�""�-
az W a°rtgag�GP�� udebted�ss un7aiE as d �eIXp� �
� n Yes ❑ No
If ovmed wNh someone aher ihan spouu,
�S I�IC PfOpEf{`/ 1(1 QU25LC
❑ R� �nr ❑
�y �, J f,SSLE
doio-d� �,
�a.�
20 _ � 20 _ � 20
R'�"a�
� � v�a�r
20
I /�"'�^�1J�JV� � K7Ii 0�- U �'(�
Ne above and foregoing in(ortnation is We and cortect arid that the applipnt is a resident ot IrWiana and
property on date application is filed.
Dal4fmorrth. daY• Y��)
riry, atate, and LP ootle)
`-7
of Attm�ey or Oy IC 61.142-07
P4tlmss d autliu'veO pgsm (numGer e� sneet cuty, sbfe.
Date (monlh. tleY• Y��