HomeMy WebLinkAboutMortgage_Lin"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
_ = FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R71 / 6-09)
� � PresQibed by DePM�rtl of loral Govemment Firence
File Mark
INSTRUCTIONS: D
wm
To be lied in person w by mail wiN the County Auditor or Counry Recorder of the counry whele the pioperty is located.
Filirg Dafes: 1) Real PiopeRy: Must file durirg the year /or which !he deduction is saught. ❑� ry Auditor
2) Mob�7e / Manulactured Homes not assessed as Real Pruperty Must f+le dunng [he fwelve (72) months
before March 31 0( each year the deducfion is sought `� Remrder
See reverse side foradtlitional instmUions end qualificafions. GIBSO
qppfuans(owner or contrad buyer - see resbicaons m rererse vee)
�istr¢i Key numbTsiTeijal desaiD�+ Recortl numEer Peqe number
! a.� -- -- a._-ao.3 -003. �� �-o a-� 009 � o
sess¢d vaqie oFreal pioperty as d Abrtqage / Contra� inde6ledness unpaiE az of Mortgage / CanTUt indebteCrress unpaid as W Is Ne epp�rant the sde
amh 7, am'rt ytar Mar� . a�rtent year � date of appG�tim �egal O itade O e(!
,!� g Yes No
no, what ts his / her eraG 51�ate ot intemsi? If ow�re0 xith someo�re other than spouse. iMicate v.ith whom
riame m 2mN'a dAferent tlun ihai ot app9carv, uMifate 6ebw. Is tl�e peny in QuesOm: Mnua�y AsscsseE
eal Property Q NrtvallyAssessed . . _
Nartre af rnortgagee m m�tract sWer l
S
pCdres, d rtprtgagce ar mntract se9er (number and street ciry, sta�. aM ZlP cade)
Name al �`�nee or oNer awner m hdder d mortga9e
Mdta55 oi assignee (number aM sneeC dty, stete, and ZIP code)
Does ePplitant ovm property in eny oNer If yes, what munt�
counry in Indvna? ❑ yes ❑ No
Deduction apprwad In C�e amount
20 _ � 20
Sig�awre N CounN Audiwr
COUNTYAUDROR
20 20
Caunry
�
�acx�4 -C�ao�
� �y,'1$� �
X i c.� L4.r� L� n
�" t� �' "^�lV�
I I We certify ur�er �he penalry ot p�rjury thal the above antl (oregoing informatlon is Vue e
owner I contraG buyer of the aforemenboned property on date appliplion is filed.
Sigrewre (orne/s hID rertre)
X; v L A„ L�„
Full resident adtlrass d appfmant (num0er and shre4 �1: �te, ar�d ZIP cotla)
30ci-- t D�� 5�-��.V� � r t n C..l�t+'h Z N �I '! �1- % b
Person auNOrized Gy OWy ezecuted Power of AtiomeY a M IC G1.1-12-0.7
person (number arM sheet, cRy, sYate,
��
oa�e (,�r�. ear,