HomeMy WebLinkAboutMortgage_Harmon"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C Townshi vear
._-_ _; FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fwm 43709 (R71 / 6-09)
�' w� r Presai0ed by Departmenl of Loml GovemrtrerLL Fnance
File Mark
INSTRUCTIONS:
To be filed in person a by mail vnN the CountyAuditor or Counry Recorder o/ the county wF�e2 tAe propeny is located.
FiNng Dafes: 7) Real Property: Must file dunng the year for which tha deduction is sought. � �unry Auditor
2) Mo6i/e / Manu/actu2d Hortres rw1 assessed as Real Pmperly Must file dunng the hveNe (72J months ,�I /���
6efora MarcA 31 0/ each year the deduction rs sought � 13 �`C6'fr7t;t Recorder
GIBSO v ��
See revers�sade /oradditional instructions and qualrficafions. ITOR
IAG moonvarfbuyxr-seere�ctricOOrumr�verus'xh) l
K6V nimber / 1e9a1 desaiPtion Remrt1 rwmber
,:�✓ �a 6-� -o �- Yo�{ - ovo. �l s �- o a- 8 � o0 9
property at d ' Mortgage / Cantraa'vide6teOness unpaid as af Mortgage / Conraq inEebteCness unpalO as of 1
C�
If name m recorE is dAferen[ Nan Nat ol app�ani, mtlinte heb�r.
Nameotrtartgag�eu/`�Li(..l.�/�'YL.� J�-�4— `��
1 .
AGd� W rtartgagee u contracc se0er (numbrl and sm
Name ot astignee w oNe1 awner or IwWer W morigage
Dces aPditant ovm property in eny oNer
munry in Indiana? ❑ Yes
❑ No
Orauction apryoved in Ma amount
20
SigfaWre N Camty AW imr
I I e certify u�e
owner / mntract buye
sig�uwre /s/�na
FWlresiden----�
.5�30 S. '
Person aullroirzetl by dWy f
arid ZIP Code)
If yes, what county7
20 — � 20
someone
spouse,
number
iRable ovmeR
Yes ❑ No
b Me P�PertY in Ouestion: MnuaM Assessed
�] Real Roperty ❑ Armually Assessed
Di•a�ti�er i\'O..a. V �? .`�.-......
C11'(� l�i�. .,;� � 9
What Ta�dfg D • • . •
20 � 20 � 20 � 20
i��
penalty o( perju fj that Ne above arW (oregoing information is We and correU and that Ne applicant is a resident of IrWiana arM
of the aforementioned property on date appiipbon is fiied.
� � �. / . Date (rtnndi. daY. Yaa�
- ivtivv�i�
Ser and street aN,
person (number a�M sbee; tify, state. anC ZIP code)
Date (monN, tlay, yea�
�V