HomeMy WebLinkAboutMortgage_Hedge"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__,_ = FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Fortn 43709 (R71 / 609) . � g � �
� 2 PrewiOetl q' DeVartmeM af Loml Govemment Frence �
"° File Mark
�STRUCTIONS: F� � �:
6e filed in person a by mail wi�h the CountyAuditw or Counry Recorder o( fhe countp�h�reAhSJprQ,�y is bcated.
Filing Dates: 7J Real Property: Must �Je during Ne year /or which the deduclion is soujM1!' b � Counry Auditnr
2) Mo6ile / Manulectured Homes not assessed as Real Property Must file da �n the (12) months
be/fo�re Ma�ch 31 o(each year the deduction is saqht C.�. ❑ County Recarder
See reverse side kr additionel inswUions a�4ualifi�(ions. , �
m
i mal P�oPertY a
Y�
�'�' a�=�a_ �� �r�oo�. �,
�/ ConUaa'ude6ledrress unPaitl as d Mortgage / ConttaG
airte�rt Y� �('��CJII date of sPP��
J
hare ot intemsl? If awned wiN sameone other'
Nan thal W appfrant u�Eirate DeWw
Name W mwtgagee or mntrad seller
AddRSS of mortgagce or mntract sW
Name of assignee w oNer owner w t
aro streey/ay. sram.
�
AOCress ot assigtree (number a� sbee4 �4Y. slare. eM Z/P code)
Oces applianl ovm WoVertY i^'•••. _••'"" _ — . — _ — - �g Distrid?
munty in Ind'ana? r .
L
Dedumon app�oveE c� the am
20
�nn) II/
D1':111'C1'���...l�•v!• ...•.....
C91"C� \�. ... /�:!.1.........
� y5,�.c�v
Sig�uture qowit� diro
I I We certify under the penalry of perju� at the above anA for
owner I mnhad buyer of �he aforementbned property on date
,SignaWrej�owneh/utlname) � /
I �%/,2.t.cM
�_revCeM aONes of.appfimnt (numDe� and sbeel. af , state, arN ZIP m
o tl�v � Ohc� Sf PR
Person autha¢e0 Ey dWy ezeanea Power o(lWOrrey M by IC 61.1-12-0.7
pddren pf aulhomEd De� (number aiMN stn•et dry. state, and ZIP code)
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�O r5�nta rprtper�� ra9e nun J I"
G (� �� �
btedn�s unGaid as of Is Ne eGG�^t Ne sde
�gal w equita6le ovme(?
❑ Yes ❑ No
spou:e. mdicate um, whom
Is tl�e poperty in Question: Mm�alty Assrssed
❑ Real ProPertY ❑ ?n�!�aIN A�s� . . _
Nas N's Cetlurtion Eeen repuesfe.W on P�Y
fw wnent YPan ❑ Yes ❑ No
�_ �
Datc (rnonlh. Oa . year� �., � I I
"'a LJ
umalion is We and correrl aM that Me applipnt is a residem of IrWiana and
is fiietl.
Dare (rtomh, Aay, yee�
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