HomeMy WebLinkAboutMortgage_Ingraml�
\
(
"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
,__ , FOR DEDUCTION FROM ASSESSED VALUATION
Smta Fwm 43709IR71 / 6-09)
`' ur Presaibed by DePartmeM o( Lod Govemmetrt Finante
INSTRUCTIONS:
To 6e filed in person or by maii with the CowtyAUditw or Counry Recorder o! Ne county wliere the properry is located.
Fifing Dates: 1 J Real Property: Must file during the year lor which the detluclion is saght
2) Mobde / ManuFactured Homes not assessed as Real Pmperty: Must file durfi�g the tweHe (72J monNs
betore March 31 of each year the deduction is sayh[.
See reverse side (or addifione! instrudions and qualillcations.
AppG�ant (owner or contracf buyerisee mstrirtions m rererse � �
�ii n. �.>e � i ii�a.iw i i .
1 Qou�AFi%fitor
Counry Recordu
COUNTY AUDITOF
mber Page number
I'y"/U:�c�-r*� - vi a_o� -yoi -ooi. 3aK-o a- �s�
As�ed raqc d� qaperty a d Abrtp age/ Cantraa Inde6teErress unpaid as of Mongage / Contraa 6Wehtedness unpaitl as d Is Me eppfrcant the sda
Mazdi 1, qmnt yrar Ma2h 1, wrtent year tlate of appOtation legal or epuilade awneR
❑ Yes ❑ No
rc ro, wha� 6 nis � ner e� �are or mv�esc? rc awrea H;n, sa,�a,e «na. aa� spw�se. mair�e wm wnom
tt rwne m remtl's dAf�t Nan tliat of apo�ca�i, mEirate 6ebw:
Name of rtpRgagee ar crnvaU sPAer
«��
wmer w nmer rn mortgage
naaress ot assgnae (numoer ana suee; cy� seie.
,vT
Dces aPplkant wm praperty in any oNer
munty in Ird'ana? f'l .,_ _
cdY. smm. eM LP mEe)
Y��
7-�-
P�G�Y m 0��: MnwOy Assessed
Dra«•cr \TO.r.a�Q1.Q
Card 1'O. ..�.r.�..%
.........
�e.o� rwfldOc�u�.d,�'carrL
� G
Has tltis tle0uction Eeen reCUesteC m P�+�Y
�w�� ❑ Yes ❑ No
' _� _ .____ _' _ _ . _ _ —_ _ 1 — "