HomeMy WebLinkAboutMortgage_McDonald"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ��
� FOR DEDUCTION FROM ASSESSED VALUATION
-��' ' State Form 43709 (R11 / 6-09) FEB 8 012
S w. P��� bY DeDahn�eM of local Govemment Fnance
F'�e pQar1��
�NSTRUCTIONS: F� �� � v �
To be filed in person w by mail with the CountyAUtlitor or Counry Recoider o! fhe county whera the piopeRy is located.
Filiig Dates: 1J Real Pmperty: Must file dunrg the year for which Ne deduction is wughL G BS� C�j�ip��(e'�TOR
2) Mo6ile / Manufactu�ed Homes rwt assessed as Real Properry: Must hie dunng Me nvelve (12J months
before March 37 0! eacA year the deducfion is sought. ❑ Counry Remrder
See reverse side for addiLOnal instrtictions arW qual�cafions.
Appfrant rwwntrdCbuye restnclior�c rseside) i
��,x�-o ��� Uza.�� f �a.�.� �.�it�r�r�,.�
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A/a�U 1, Qarent yex
no, wha[ is his / her e�1 share of interest?
-ia -o� - �� � o0 3.
curtentyear
name m remrd is d'Merent ihan that of aPP�^�. �irate bela.r.
or rnnvan
Atltlress W mortgagee w wntract seAer
Name o( assi�ee w oNer owner or hdder ot mortgage
AA��ess of assignee (number aM streeK �y. slate, and ZIP code)
Dces apyrc�anl o.m property in any o[her
W'
munty in InCiara?
❑ Yes
Detluction a0o�on.d ii tlre anwnt of.
�9
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i
If yes, what wunry?
GOU
^ . 20
,
someone
W�al Ta�dng Disiria7
20
Recortl number Pagq� /
Od� � 7
aa eWebtetlness unpaitl as d Is Ihe eppfitant tlre sale
n kgal w equitade amel.+
� ❑ Yes ❑ No
rer Ihan spouse. udicate wuh �N�wn
Is �h property in quesGan: MnuaAy Asctted
Rea� Property ❑ o,rn,ua�y Assessed
Has Ihis deCUUion Ceen reQU�teE m property
tor anrent Yea!? ❑ Yes
❑ No
20 I 20
ping infwmation is true and cortect arM lhat ihe applipnt is a resident of IrWiana ard
pfication is filed.
Date (monN, day, yeah
Oate (rtonlh, tlay, ysah