HomeMy WebLinkAboutMortgage_Meeks (5)"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ + FOR DEDUCTION FROM ASSESSED VALUATION ^
• State Fwm 43709 (R71 / fi-09) Q`"�
S y,. � PresaibeE N' DeparimeM of laral GaremmerY Fuiance
��� File Mark
INSTRUCTIONS: Form Aed wiM:
To be filed in person or by mai7 with the CounryAuditor or Counry Recwder o/ the county where the property is located.
FiNng Dates: iJ Real Pmperty Must hle durrng Ne }rear for wliich the deduclion is sought. � County Audiinr
2) Ab6de /Manufadured Homes rwt assessed as Real Property Must file durirg the hvelve (12) monfhs
before Marth 31 0( eadt year the deduction is mtght. ❑ Counry Remrder
See 2versa side for addtiona! instruclions and qualificafions.
App�qt (owner moonhact b✓Yer - jee resfn'rdars m rewrse sda) . —'
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Y�
an
Key
—M/ -U!'`Ic
Mard� 1 e I Contra��o
artent
Cut of aGP�^L hNirate Cebw.
rlama m «m,ra� seow
Pddress d mort9a9ee u cvntratl se0er
Name ol asv9nee w other ovmet or hd
e�pli�aN own 7�7�Y in any oNer
y� o-w�? p Yes I
cGOn aDWored in Cie amount oE
20 _ 20 _
.�?�I
,Cl d. r � U� o ! T �
iE as of Mongage / Cantraa iMebtedness unpaid as o( Is Me epp&ant Ne sda
'\ Eate ot aPP��^ iegal a equ�taCle vwimf)
C� ❑ Yes ❑ No
tt awned wiM � oNer Ihan s7W�. ind'Kate wiN H1mrn
Is C�e property 1n O�a�: /���Y �
Real PtoPaKY ❑ %���Y �
� eeom� rro�,e nc ��.�-;
mOftgage
stete, ar � _
�r�.nc,� �D�o-7yb
— � Has Nis tleEU�n Dew, req�� m,�W,Y
� tar wrrnrt Y�r? � Yes ❑ i
No _ _
�`." � � � �^'`J�
20 _ I 20 _ I 20 _ I 20 _ I 20
I I We certfy unE/iUe penatty of perjury t the above and foregoing intormation is we and cortea and that the applinnt is a resident of IrMiana arW
owner I contract buyer of the aforeme � ed property on date appiiration is fiied.
vawre rownels fiAI namel Data (nmCi. daY. Y�^
P�sun auCimrsed M �Y uecuteG
Aedr� of auN� p�sm (num
sbee; c4y, slate, end LP co0e)
II
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