HomeMy WebLinkAboutMortgage_Meny (2)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
, FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R71 / 6-09)
S � Presvibed by �epartment of Loml Govemrtrent Fnance
File Mark
INSTRUCTIONS: AI1
To be filed in person or by mail wi(h the CounryAuditor or Counry Recorder o/ Ne counry where the properry is located. ~u �
Filmg Dates: 7) Real P�opeRy: Must file dunng fhe year for which the detluction is sought. unry Auditor
2J Mo6de / ManuFactu2d Homes nof assessed as Real Property: Musf file dunrg the !welve (12) months C�
befae Malch 31 0/ each year the deduction is sought. ry Reconder
See reverse side (or additional instnxtbns arM qualilications. G IBSO N COU NTY
AppGCam (owneroroontrarf buver - see resMCbons on reverse sidel
m.
tt nart�e
Key nim6er I legal desaiptf�n Rem(tl � ber� Page numCu
- �.-�07-io/-ood.96 3 -o d � 3 7
property as ot Mortpage / Contrac[ irdeb[eCness unpaid as of Mort9age / ContrarY inEehtMness w�paiC as of Is Ae epplkant Ne sale
Mard� t. artenl year date of app6mtim legal a epuitade or+ie/?
-% OO O ❑ Yes ❑ No
e�a share of interest? �f wmed wkh someorre other than spouse. udimte wtrh wMm
Name of mortgagee or cuntrxt se0er 5�3
Address of rrortgagce or contrad seller (numbe� aM s1reeS �dy. slate. ard ZIP code)
Name ot assignee or other awner or holder of mortgage
AEEress of asagnee (wmber aM e4 mY sm1e. ard
Does applicant�in any oN�
muNy m InOiana? ❑ Yes ❑ No
Detluction app�oueC In �ha artrount of.
20 _ 20
sig�naedCamNnuanw— —
I/ We certify untlu Ne penalty of
owner I mntrad buyer of the afon
�re (owne/sluUnz
�Fu0 resid nt tlress of appGnnt (num6[
w . ���r� �c
Pason authofrzed Cy dM' seated Pow
MOressofau4mttredperson (numbeia
15 Ihe property in ques0an: MnuaOy AssesSed
❑ Real PropeRll ❑ MmuallyASSessed
Dra�ver i\`O. Q�Q/�.
........
c�,-d ���0�.'7. 377�.
�a y —
couNrr nuorrc.,.
20 20 20 _
Caunry
r.i��
Date (rtmlh. daY• Y��)
,�
20 _
that the abov a d(oregoing infortnation is W e and cortect arid that Ne applinnt is a resident of IrMiana aM
ned prope date applicatlon is filed.
oa�a ��,n,, ear. r�en
li •�r\(�1c 9 Q'ks7� ,� �� �I ��D � �i
meY � M IC G7.1-12-0.7 Date (rtmN. tlay, yea�
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