HomeMy WebLinkAboutMortgage_McGill"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun hi ar
s„--_ .
: FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R11 / 609)
,' y� � Presaibetl Ey Departmen� of Loral Govemment Finance
Fi a
iNSrRUCnoNS:
To be fiied in person or by mail vnN fhe CountyAuditor or Counry Recorder of the county where the property is bcated. F� �� ��
Filirg Dates: 1) Real Properry: Musf �le dunng the year lor which 1ha deduction is sought. �. ��
2) Mo6ile / Manufactured Homes not assessed as Real Property: Must �le dunrg the M1vefve (72) months
be(ore March 31 o/each year fhe deduction is sought. ❑ Coun R es
GI
See reverse side for addifional instructions and qual�rafaons.
Appficam (oy�ne� ortonMaC buyer - see resjrirbbn3.on reverse sitlej "y �y,�/y—� /
� / / / �/ (/
�h�� ���. �97• �c7�
Asessed vahie d mal p'operty as of ' AbRqage / ContraU intleh
Ma�di 1. amnt year Mam3� 1, airtent year
Iq. whai IS his / her eratl sharB 01 intere5t?
If �rtie on rcmA is dift¢RM Nan Ih2� O( aPP�^�.'udiqte b¢bw:
Name of mortgagee or mnttaG seller �
� Q �,.
Address of mortga9ee «cantract se4er Inumbe� G rity. srare. ane:
Name ot assignee w other owner or hdder of morigage
AECress of auig�e (numDer aM stree4 a1y. sla+e, and ZIP cotl
Ooes apptzant wm pmperry in any other If yes, what munln
counry in IMiana? .
❑ Yes ❑ No
20 I 20_ — � 20_ __
mneane
Whai Tadng Dislric�?
_ "�
� Dra�ver NO.�..Q.�.�.--.....
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Recad num6er Page nursibv
O// ' ��o
ss un0aid az of Is ihe sOP�i the =^�°
iegal w e9���de o�vrn�
�O � ❑ Yes ❑ No
;. iM�iCa2e wBh wFnm
property in VuesOOn: MmiaOy hsses5ed
� �roaenv ❑ armuaih assessed
Modle Fiane (IC G7.1-�
Has N¢ deEUdiat Eeen requested on pmpcty
(Of WlR11t )'C2(1 n n
�
��
20
I/ We certify uMer Ne penalry of per C � 1� (I �� O. ..��!�. 0. ....... �� arM Nat Ne appliqnt is a resident of Indiana arM
owner I contraa buyer of the afaemE
(owne/s na ) � Oate (monfh. daY.YsaA
resi em atltlr¢ss ol a nt (num6ei a�
I� b 3�A�uw�rau i�h rnn�u-c�c.�,oT �� �(n�c�
rson autlwfrzed Gy duly esecuted Pov.er of Morney w by IC G7.1-12-0.7 Oale (month, dey, yea�
Pdd(¢s of authoraed person (num0eraiM sbee; ciry, state,