HomeMy WebLinkAboutMortgage_Echelbarger"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court
__ , FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fortn 43709 (R71 / 6-09)
S�«. f PrewibeE M �ePartmeM W Local Govemment Fuance
INSTRUCTIONS:
To be filed in person or by mad wiN the CountyAuditor or Counry Remrder o( fhe county where the ploperty is located.
Fifirg Dates: 7) Real Property: Must file dunrg fhe year /or which tlie deduction is wught.
2) Mo6de / Manufadured Homes nof assessed as Real Property: Mus! file dunng the fweNe (12) months
6etora Malch 37 0! each year the deducfion is srought.
See 2v�r e side 7a adtlilional insWClions and qualificafions. .. _
IAVP� �( wnerqronva�(DuyeL'seere�nrboAsA"rerersevCe) ' ' � .. _..w
Ii rb. whai Is Ns l lrer exad slure oi InWlesi'l
If name m remrE a EiRrm�t Nan Nat ol applkant, uidKate Eebw
Name of rtmr4�agee « contract setler
Pddress d mrtgagrs or mntrarl se�er
•E=' E
as
Fortn
¢� Auditor
County Recarder
of 'I Is Me appOfanl the sale
legal or epuRable o�me(?
❑ Yes ❑ NO
If wmed vrith someofre other than spouse. imfrate wNh whom
Is tlu property in a�astiw+: Mrwauy Assessea
❑ Real a.oaem ❑ iNnual!r Asse��
Name of assignee w oNer owner ar halder of nwrtgage `
AdEress ot azsignee (numDar ard street �Y. state. antl L D 1� 11'� i' l�i �. ..� � �
� BinalMiatu? P�P�Y in any oNer It: l.. a 1�(I �i O. ....� /�� for artendeducGm Eeen reQUestetl m praprny
❑ Yes ❑ No ... �.� ......
� ❑ Yes ❑ No
De�umon a7G� m tlre amount of. �"` I I(,j� J�� •� v
20 20 _ 20 _ 20 _ 20 20 _ 20 _
Signanne U Cam�Y Auebnr Caunry Date (irnrvh, daY. Y��
I I We certrfy u�er Ue penalry of perjury that Ne above and (oregoing in(ortnalion is We end cortect arW that the appli�ant is a resident of IrMiana arM
owner f mntract buyer ot the afaeme�rtioned property on date application is filed.
Sia�a]Im (oMner's�/e9lemel—�— Dare (+m+fi. daY• Ma�
Fulltesident�''a9d�s of apofrc.ai(t�(numberand 512ef, dty, stafe, ard ZIP oode)
V �/ j/ A
� ,� S�% �7it�y�in II.IA✓{ �:l�rl ��i.�/
�onautln�¢edDyOWyexeai' WxerafAttwneyorOyICG7.7-12-0.7
lddress of autl�w'ved person (numberaM sbeeL �+ry, sbfe, an0 ZIP cade)
(monlh, tlaY. Y��