HomeMy WebLinkAboutMortgage_Lawrence""* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,.__ � FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Fwm 43709 (R11/609) � /1
�' ,.,. � PresrnbeE by OepartmeM of Lafal GovemrtreM Fnance � O.
� File Mark
�STRUCTIONS: �'\�
To be ned in person or by mail wdh the CounryAuditor or Counry Recorder of the counry where tl�e propeRy is located. F� �� ��
Filirg Dates: 7) Real Property: Must file durirg Ne year /or which tha deduclion is sought. Couny Auditnr
2) Mobde / Manufactured Homes nof assessed as Real Property Must file d�nrg fhe twelve (72) months
6efo2 Mamh 31 07 each year the deduction is saighL County Recorder
See reverse side for addtional insLUCtions and qualifications.
AppGCant(o rormntradbuyer-seare�y� revtrse5ide)
�� /� „0/in l Yl�i�noM.nQ ��� a �u �9
Key �wmbe(/ legal desaiption
property as W I Monpage / Conbact iMebteCness
Mardi 1, n�rtent year
It rurt�e m reootd "s dit:uent Nan Nat of apptican4 mduate Cebw.
W me ot mort�agee a n d eller
ACd25s o( mort9ayce or contraG S er (�
Name ot assignee w other ovmer w Iroldi
Add�ess of assgnee (number aiM sfine4
Daes epplicanl own pfoperty in any oUer
munry in IMiana?
❑ Yes
I
Dglutlion approved in Ne artaunyof:
ii�
20 20 _
Signawa of CounN nW iror
Ser end sbee4 �y. sbte, arN ZIP code)
mort9ag8
slafe. and Z/P cade)
I! yes, what count�%�
I No
� �z�
'��
Mwtgage / Contract'uMebtedness unpaid as of Is Ne a0d��t Me sde
tlate of applifation legal w epuitahle owneR
❑ Yes ❑ No
rrith someo� othu than spouse. i(Wirate with wlnm
What Taprg D'alria7
\UDROR
�20
Is Uie property in question: MnuaP/ As5e5uE
�lf2eal Property ❑ Purtiva0y Pssened
7�•� M1bdle Fim�ellC 6
Has ihis dedurlbn been reQUesteE m pmpetty
forwrtentyeaY.� ❑ I
❑ Yes
_ �
2(1 20 _
Date (rtronlA. day, Ysa�
I I We certify under the penalry of perjury that the above and foregoing in(ortnalion is We and cortect arM ihat Ne applinnt is a resident of IrMiana aM
owner / mntraci buyer of the afotemeMioned property on date applicalion is filed.
sheet. ary. sfate. ana zIP mde)
��
�7ttm�e�yrnEvy IL61.142-0
F� � � �
of author'ved persw� (number aM sbee4 �y. sbfe. an0
G
Date (rt+onN, daY. Yee�)