HomeMy WebLinkAboutMortgage_Giles^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ .� FOR DEDUCTION FROM ASSESSED VALUATION
• S1ate Fortn 43709 (R11 / 609)
S w,� , Presaibed by Oepartmenl of Laral Govemment Frence
INSTRUCTIONS:
To be filed in person w by mail with the County Auditor or Counry Remrder o! the counry where the property is located.
Filmg Dates: 1 J Real Pmperty: Musf file durirg the year for which the deduclion is sought.
2) Mobile / Manu7actu2d Homes rrot assessed as Real Property: Must file dunng Ihe fwelve (72) months
before March 31 o/each year the deducliwr is sought.
See reverse side 7ar additional insVUCdons arM qualifications.
Appfic�ll'fox�E�y traUDUyer-seeresNifliyram $ltlea
Asrssed vdkie of real VoO�Y es ol Mort9a9e / Contrati u
Martl� 1. aamG yPar Mard� 1. wrtent year
I( ro. wha� 15 his I her ezaG 5hare Of interesl?
H nazne rn remrtl's tlitfera�t Nan ihat of app6iant, 4Wirate bebw:
'�cpwuditnr
Caunty Recorder
� (/v/ • / / �CJOI J Cllv`'' / / !
s unPaid as W Mongage / Cantrx2 inAebtedr�s �mCaitl a d Is the ePO�t Me mle
Eate ol a0 le9al «eQuitade a�meY.+
❑ Yes ❑ No
If ovmed wiN mmewie dher Ihan spouse. iMrcate with whom
property in Question: MnuaOyAssesse0
Real Property ❑ AtmUally Asse55ed
hbdle F�lortie fIC 61.1-i
Name m rtrtvtgagee ar contract 5eller �,�
/�.PD�(/m /"/ �
Addrea of mortgagee or cantract xller (num0ei and sbee/, ciry, sta:e, aM ZIP code)
Name W assi9nea or othn owner or hdder M mortgage . .
Mdress ot assignee (num0er aM"—"—
Oces e�ifant ovm property in an
oounryinlnEana? n Yt
Ihe amoun
� I �
Dra�vcr NO....���./......
Card NO. .... �/�/� .....
�b � i , �-/ OU . Ci�
���
F:��
Nas Nia aea�ma, eee� repu�stea a, vroa�`i
for wrtent yeal? ❑ Y� ❑ I
zo_ � zo_
�i»n,re a camty a,eitor I county I oate (nmrh, ear. r��
I/ We ceNfy under the penalry of perjury Nat the above arW toregoing information is We and cortect arW Nat Ne applinnt is a resident of Indiana arM
owner I contract buyer of the atorementioned properry on date apDlication is filed.
19iwre toW�� /utl nertre) _ _ j(� �tF (^i°r�th. QaY. Yga�)
Full revGe t�dflre5s ot Ikant (num6er antl sheef, rily, state, arM Z1P code) '
5 0 �,J• �'1 t� �, � N
Person auNOmetl by dury exewted Power of ey or by IC 61.1-12-0.) Date (monN, day, yea�
Address of auNOi¢ed person (number arM sbee; cily, stare, aM LP tode) .