HomeMy WebLinkAboutMortgage_Jorden"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship vear
__ , FOR DEDUCTION FROM ASSESSED VALUATION
State Fartn 43709 (R71 / 6-W )
� � PresaibeC Ey DepartmeM of Local Govemmerd Firiance
Fi e a
INSTRUCTIONS:
To be filed in person or by mail wrfh [he CounryAUditor or Counry Recorder of the munty where the pioperty is located.
Filing Dates: 1) Real Pmperty: Must file durirg the year /or which the deduction is sought.
2) Mo6de / Manufeduied hbmes rat assessed az Real Pmperty: Must file dunrg the nvelve (72J months
before Ma�ch 37 0/ each year the deduction is swghG
See reverse side for addilional instrucGbns and qualifications. �; I
County Auditnr
�pBAp� Recorder
ar - '7- �o�-
ed rahc d real papetfj as d Mortpag e/ Contract iMebteEncss
A/&tl11. anent Y� Marf}� 1. arterrt yrar
I �9� �00
tt ro. what ts his! her e�ad share ot Interest?
tl riame m Rmtd'6 dRtemnl Ihan Ihat ot a7P�^L hNipte Debw.
Nama of rtnrtgagee «mntrarl
sLSel, ci�'. sfete. aM
Name of assi�ee w dhu wmer w halder W rtnrtgage
PdE�ass ot assignce (numGer end saee4 �N: s�, antl LP catle)
Does epplimm wm property in eny other I( yes, what
cauntyminOiana? I"I .,__ I—I .�_
DeCucOOn approved "u� Cie amount
�/ �i/-o a8
i as of Mongaga I ConTaG'vi0ebtetlr�ss uipaid as d Is Ne appOrant the
tlate of app�Catrm legal a eqWta6le owne/1
❑ Yes ❑ No
tt owned with sortwrone oNer tlun spouse. IMicata wflh hiiom
is p�e property in Question: MnuaOy 0.ssesuE
Real P(operty � AtmualyAssessed
W�at Tari(g D"atr'u]7 I Has tha dedumon Deen requested m p�opvry
t� �� �n ❑ Yes ❑ No
20 20 _ 20 _ 20 _ 20 _ 20 _ 20 _
SignaWreotCambAUtlitor � Caunry Dstafmonlh.daY.Y��
I/ We cerOfy uMer penatty of perjury t Ne above aM foregoing intomiation is We and correG arW that the appluant is a resident of IrMiana aM
owner / mntrad buyer ot the afaemertbw�ea property on date appiication is filed.
Siurenue lowne/s (� namel Date (rtmM. daY. Y��
Fup resident addres� W apj$pnl (/� fn0e� arM slreet �ry. state, and LP m
, 2 51�� �o I N �1�
Puson author'¢ed �y Cuh/ exeaRed Power dAtlomeY a bY IC 61.1-12-0.7
Pdtlmss d auCwr'ved person (number arM sncet ciN, stale. entl LP cade�