HomeMy WebLinkAboutMortgage_Hornback (2)� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun'.
__ ., FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R17 / 6-09)
�,,,, � Presaibetl q' DeparimeM of LcW Govemrtrerit Firenre �
INSTRUCTIONS:
b 6e fiied in person w by mail with the CountyAuditor w Counry Recnrder o/ the counry where the property is located-
Fitirg Dates: 7) Real Property: M�st file durirg the year for which Ne tleduclaon is sought
2J Mobde / Manufactured hbmes not assrsced as Real PmpeRy: Must file durirg the M1reHe (12) monfhs
before March 31 0! each year Ne deducton is sanght.
See revarse si0e Por adUitional instrucNons end qualrfications.
�. np n t(owner oroorinart buy�' aeqqstrirbon/in reyerse side) /� � I A .
m
� �L 'IJIJ.
piopelty as d MoRBa9e / Contract "v
Ma`U 1. wrtcrt yrar
e�1 share 01 inferest?
iRe�en� lhan Nat N app0�ant, 6�Oipte Oebw:
Name W mortBaBee or mntrad x4er
naaress a mortqayrP or mno-aa smer
Name ot assignee or otha owner a Mmer ot moriga9e
diwrc ovm poperty in eny oMer
IrWgna?
❑ Yes
Deductlon ePWOVad'v� Me amount
� I �
SignaNee N Co�mty AW ilor
b Ni
�
someona dher Ihan sPO�. "vdKete with whan
�nt dre sde
ritade mmeR
Yes ❑ No
Is ttre property in puesbm: MnuaOy Ase55eE
❑ Real ProPeKY ❑ A^^ua11Y Pss�sed
r�ty, stete. aM'•,, �_.'-•. . . ' _
��pQ ►� !3/k- � QF�L� m� uo 5�a� �
❑ N� ED '4�'ll�ll� SO
av�v-- �v� 9
�
rec�es�ea d, o�cenr
❑ Yes ❑ No
Data (rtanth. 08Y Y��
��:
I I We certfy ufber Ne penalry of perjury that the above aM foregoing intwmation is We and correG arW Nat the applirant is a resident of IrMiana ard
er I wntract 6uyer ot the afaeme�rtioned property on date application is filed. -
vawre �o»varsMim nanml _/ , n oate (monm. mr. rsa�
�Y
w by
person (numberarM sbae; ciry, state. arM
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