HomeMy WebLinkAboutMortgage_Massey^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T h' Year
__ = FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Fwm 43709 (R11 / 609)
, d Presaibed by Department of Local Govemment France
INSTRUCTIONS: � MAR 1F
To 6e fi(ed in person or 6y mail with the CountyAUditof or County Recorder o( the cuunry where the pioperry is bcated. C� F� �� �'
FiHrg Dates: i) Real Pmperty: Musf file during the year for which the deduction is soaght. unry Auditor
2) Mo6�7e / Manufedured Homes rro[ assessed as Real PiopeRy Must file dunng the fweNe (12) months
before March 37 ofeach yearthe deduction is sought GIBSON C U AUDI ry Recorder
See reverse side 7or addifional instructfons and qualifications.
MP��i( mmnfravbuyer-seeiestrisbawpnreverseside)
Ta�qr(g.0i�tiU ' I Key numbu / legal d� ; tion
t
j�� oY0 A '0 �
A�sed vapie cf real P�G�Y as of I A/onBa9e / Contrarl'ude
'1alU1 7. wmfG'/tlf Mal(31 1 ql/���l yeflr
� �(C/ �a0
If m. what is his / Icer exact shara of intrJest?
If nartie on remN a N^senl Nan �hat of app�can; uWUa[e Eebw:
Name ot ee or mntract sNler •
AOdr� W� mntract se�er (nurtiber d sbee{ �y, �fg�, arN
Name of assignee w oNn1 owner or twWer m rtprtgage
MEress o( assi�ee (number a 4�: stafe, and mtle)
Does apd�u � P�P�Y �^ any oNer If yes, what munty7
couHyinlndana? ❑ Yes ❑ No
�uction approveC m ihe amount of.
20 _ 20 2q _
R
I I We cerVfy under Ne penalry of perjury that yJ� above and fo
owner I contracl buyer ot ihe aForememimed��iroperty on date
Person autlro�ae0 Gy
■r�- —
, and
w Cy
(numbera� sbee4 �y, sbte. antl ZIP wde)
Recard numMr Page numbu
- �o,i -ODd.32�6•07• ao� � i � a�
ross unpaid as d Mongage I ContrarY mdebtedness �mpaid as d Is Ihe app�nt Me sde
Eate of appGption legal or eQUitatle oxneR
❑ Yes ❑ No
If wmad wiN someorre oNer Ihan spouse. IM'cate wiM whom
is Cre P�Ve+�Y in Question: MmiaOy Assessed
❑ Real Rnperty ❑ MnUally Assessed
Mob'le Fbme IC 61.1-:
�ode)
_'.�'!_�.^ .
0 9 PT
What Tad�g D'atrict7
20 � 2(1
Dra�ver ��'o:...°2°�.�.........
Cal'd 1\`O. .....�. �
�. � �15(0, rn� � .......
20 _ � _ _
Date (rtpntn. CaY. Y�A
infortnation is W e and cortect arW Nat the applinn[ is a resident of IrMiana aM
ion is filed.
% � C U
n��(monN.daY.: