HomeMy WebLinkAboutMortgage_McEllhiney (9)^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__, • FOR DEDUCTION FROM ASSESSED VALUATION
Sta[e Fortn 43709 (R71 / 6-09) ��^{ g
S,w ? p��p� py pe�rtmeM o( Loral Govemment Fu�ance � R
� File Mark
TRUCTIONS: F� �� �:
To 6e filed in person w by mail with the CountyAUditw or Counry Recorder o/ tAe county where,[p@,propMVVn 4xated.
Filing Dates: i) Real Property: Must file dunng fhe year for which the deducfion is soughL M/-11 1 O�LU I L County Audiwr
2) Mobde /Manufectured Hanes rrot assessed as Real Property Must fiie dunng fhe tweAz (12) monfhs
6efore Marth 31 07 each year Ihe deductinn is soughG C.�. n`„3 " V Counry Recorder
See reverse side /or additional instrucUOns arM qualifications. ry
AvP�m(owneror �r ��nreve idiZ _�--,. \ ..C'/"+Sll ri n. n I
MaRh 1. amerrt Y�r
�i f10. Vl�12� 6 �15 � hCf BYdf�
If rame on recatl is Aifela
—� 5_I i
a oontract
Keyiwmber/ 1 '
- a-o �-� o �-o
Mor(ga9e / Contract'udebtedness unpaid as of
Mamh 1. artent Y� �. .-. _ _ _
of appficant. rtdi�ate bebw.
�_ _ _ _—___ _ .' _Ye)
xhal
�Dra�r�er NO.. �'�\�' ........
Card NO. 1\",l.
.......... ......
20 — � � — � 20
���re��a,�o� r r I cQ,�c�o�
I/ We ceNiy under Ne penalry of pe�ury Mat e above and fc
owner I conVacl buver of Ne aforementioned property on date
��
COUNTY AUDf
20 _
�3a�1 W � r2 �-� . �. �
Person a Wro�rzed by Cuty exewtetl Power of Ntm�ey w by IC 61.1-12-0.7
Atldress of auNa¢etl persa+ (numDerarM svee; ary, state, aM LP cade)
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Page numb�i
I � �
tgage I Cmtra[Y'uMeMedn�v �mpaid as of Is Ne appfmant Ne sole
�. of aOP�� lega� w eVUilade awneR
❑ Yes ❑ No
mmeone dher than spouse, iMipte wilh whan
�3 I�12 pfUpCl�' If1 QUE5110fL iYlfllld� p55255Cd
❑ Real PmGenY ❑ �.!?n!ailY Asse� , .
SteC m prOperty
v� ❑ i
�_
I�nry l01 �6!'V �F--te (monRi. daY. Yaan
infortnalion is We and cortec[ arM �hat Ne applinnt is a resident of Indiana aM
ion is filed.
Date (mwYh, day, yea�
S���l�z_
v� �-�� v, , � N �-k�� �
Date (month, dal: Ysa�)