HomeMy WebLinkAboutMortgage_McCormick� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun shi Year
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fwm 43709 (R71 / 6-09)
� w. PresaiEeO by Departme�d or Locai Govemrtrem Fuarce
File Mark
INSTRUCTIONS:
To 6e fiied in person a by mail with the County Auditor or Counry Recorder oi the counry where the pioperty is located. F� m�
FiNng Dates: 1) Real Property: Must file Curirg the }rear /or which the deduction is sought. Coun Auditor
2) Mob�7e / Manufactured Fbmes not assessed as Real Property: Must file dunng the twelve (12) months ry
be(ore March 37 of each yEar the deducfion is soughG �
See reverse side
and qualificatnons. .
xit m revars�cideL •
AssesseE vaWe af real 7�P�Y as d Mortpag e/ Conbact ir
Merti� 1. tarrelrt year Mam}i 1, airtent year
1
'n no. wnat 5 tus � ner euft share or inierest?
tt rwne m remrC's SAfrmit Nan Ihat N appOCant,'u�Eicate Debw.
Name ot matgagee or contrar2 seller
Pdd2ss d rtnrcgagee or mntraG se0er (nuriber end sn
Name al asvry�ee w dhu wmer w halder d mortgaga
Fdtlress ot assignee (numDar eM streaL dy, s7sb
Dces eQptifanl ovm property in any oNer
�,�uy �, i�a0r��
❑ res ❑ No
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�
20 _ 20 _
siqrenae d Camb Auaitor
ffim.
IfowneO
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Dra���er \O,•; .......
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a
� o. .. ► 593.......�,.
�4 �47�Q�'
e.[���;u
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a
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spouse, indi�te with whom
hbble awnM
Yes ❑ No
Is rt�e W�Y in auestion: /vinuaM AssesseC
❑ F2eal ProPertY ❑ %vmuallYAsse�ed
20
oa�e (�alw, ear. r�A
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1/ We certify under Ihe penatty of perjury that the above arid foregoing information i5 true and mrrect aM that ihe appliran[ is a resident of IMiana aM
owner / contracl buyer of Ihe aforemerttloned property on date application is filed.
1 wneh flID namel _ _ / �� (��. �Y. Yge�
state,
of Morney w by IC 61.7-72-0]
AEtlress of auCror'¢ed persm (numGereM sbeeL �: sbte. and LP code)
Date (rtrorrth. EaY. Y��