HomeMy WebLinkAboutMortgage_Howell (5)'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�_ • FOR DEDUCTION FROM ASSESSED VALUATION
State Fom 43709 (Ri1/6-09)
�' y,� P Presrnbed by DeP�rR al Loml Governmerq Fifw¢e �
File Mark
INSTRUCTIONS:
b be filed in person w 6y mad with fhe CountyAuditor or Counry Recorder of the counry wAere the pioperry is located. A P F
FNrg Dates: i) Real PropeRy: Must file duri�q Ne year (or which fha deduction is sought. ounry Auditw
2) Mo6�7e / Manuledumd hbmes rat assessed as Real Prt�perty: Must file dunrig the twelve (12) monNs—a.j� �
6efore March 31 of each year the deduUion is swght. //'r nry Remrder
/
S6e revelSe Side 7o! addAiOnaf insfrt/ClID!!s and afleliflC260ns. (:I RSnN CN I PI7 v e 11nITnR
Assesse0 vahie af real P�Y ��
MaN� 1, tlr�vrt yrvr
Key rnim6er / legal desoiPtion
d�6-l�i �- a3-o�o•BaSA �
�Ma1gage/Contrac['udebteEnessunpaidasd Mwtgage/COntra
I Msrch 1, wrtentHe9V� Eate of eppGCabm
ro� xTat ts his / hu exa�Y share of inte�est?
It nane m refA�d is dflferent than that
or mntract scwer ' � I �
e�+.. mntraC seAer (numDer end strae; cify, sbm, a ZIP a
Name of as
nEdRSSOt ��(/C� � 1 4 � l/�
unpaiC es of I Is iha epp8ranl the sok
legal or equitada mmen
❑ Yes ❑ No
If owne0 with someoro dher C�an spausa, Irdkate wtth whom
Is the property in 0���: �nueity Assessed
❑ Real RoGerty ❑ Armually Assassed
Modle Fiort�e fIC G
Dces B(�pli I Wlwt Tari� DistrirlT I Has Na deEUCim Deen requested an propeRy
munry in 6 n/�) ^/� ? tor a�rent yeaR
!/�`i�D l / �J ❑ Yes ❑ Ni
COUNTVAUDROR
Deducaon
2p _ 20 _ 20 _ 20 _ 20 _ 20 _ 2(1 _
� � I �nry � (�y � O �� O
I I We cerbfy u u �he atty of perjury t the above and foregoing infortnalion is We and cortect ar�d Nat Ne appiicant is a resident o( IrWiana and
o.mer I mntracY buyer ot ihe ahxeme � property on date application is filed.
TG�.__. c�J �f' J-.��{, ��
i0ent aOCmss d appfimnt (number antl sbce4 �1: s+a1e, ard Z!P oode
6 z9 Nt P k� �,.� s� � ��,� ce -� ,.. ��F � 6 �
autlamed �y dWy exerLted Power W Anamey or by IC G7.1-72-0.7
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