HomeMy WebLinkAboutMortgage_Lasley (2)I/ "•�a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
��,_ : FOR DEDUCTION FROM ASSESSED VALUATION
�. � Stata Fortn 43709 (R11 / 6-09) ` � T��
� u» Presrnbetl by OepaRment al Laml Govermmnl Frence \ y 0
� \ 1 File Mark
INSTRUCTIONS:
Fortn Aed with:
To 6e filed in person w by mail wifh the County Auditor or Counry RecoNer o� the counry wbeqlthppropyM�6located.
Fdirg Dates: 7) Real Pmperty: Must file during the yearlor which Ma detluction is soughGlVl/i I J L U 1 I Cowry Auditor
2) Mob�7e / ManWaUUred Homes rrot assessed as Real Property: Must file dun�g the hvelve (12) months
6etoie March 31 oJ each year fhe deduction is soughL C. j. f�" Counry Recorder
( \ `\See reverse side for additional instruUions and qualifications. V�
App6mm(ownern buyer-seeresLirtionsor/reve � e) /� ��SUNTY AUDITOR
fistrsY Key rnimppl / I¢yal d�� // ��� Ab � O e� �� Recpd num O Page rw�
40 (QT
d vaWe U reW propelty az of Martg�ge / Conbaa 4Ne0tedness unpaid as d Mortgage I Contracl i�WebteA�wst unpaiO as d Is Ne epplkant Ne sde
. armnt year MeiU 1, wrrent yrar Oate o( aPpfimtion legal a equilade mmM
�OO� ❑ Yes ❑ No
al'a ha 1 her esaG shate O( interest? If axned with snmeone oNU ihan spouse. iMxafe with wirom
m recotd s tliRemnt than �hai ol aPP�N. ��te belaw. Is the pmperty in Quesdm: MrivaDy Asses�e0
� Real Ptopetty � MmUally 0.55gsed
Name af rtrvtgagee ar mntraG se4er
Address W nwrt�agee contract seller (n er and sfreeG rny. stam. ane
Name of assignea w othg owrrer or hdder o( mortgage
Ooes apptitant ovm prapem� in any
muuv in �neana?
F1as
forc
�i
U Ye5 /l � L! Yes LJ fVi
lll"111'CI' �'�....��I V....
DeAucCOn approved in the amount af: /�2
Card NO. ..... �.�;/ J.....
zo so _ _ zo zo
SyiaW2 N Aud Counry Date (rtnNh. day. lea�
1/ We certfy under the penalry ot perjury tha e above and for ng infortnalion is true and cortect arW Nat Ne applinnt is a resident of IMiana arW
owner I contracl buyer of the aforemerrtioned property on date appliration is filed.
s ot appG�ant (num6eT'and sbee4 �; ��e, antl LPmtle)
f. i✓��� ac+C ,t'r�vcEi� ,� r�v O �1 �6 7 v
Gy OWy ezecutetl Power of Attomey w by IC 61.1-12-0.7 Date (rtpnN, Eay, yae�
red person (numDer and sbee; ciry, slate, and LP code) .