HomeMy WebLinkAboutMortgage_Mitchell (5)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou mwns Y r
___ : FOR DEDUCTION FROM ASSESSED VALUATION �
� State Fwm 43709 (R77 / 609)
�' f Presaibed by Oepartment of Local Govemment Fnance
utF� �+ar� 2009
INSTRUCTIONS:
To be fiied in person w by mail with the CountyAuditor or Counry Recorder o/ Ne county whem the property is located. �� �� ��
Filirg Dates: i) Real Pmperty: Must Ale durirn� fhe year hr which the deduction is sought �� 6o�udimr
2) Mobile / Manu/actured Homes no1 assessed as Real Property: Must fiie dunng the twelve (72) monfhs
6efae March 37 0l each year the deduction is sought GIBS N N�4� �Sii�
See reverse side for addifronal insVUCtions and qual�cations.
MP�m�� ( ar aontract buye� - 3eP m�^�4�� °�Y°Fe �EL. %%
I vdNe af real pmpE�:y
arrelrt yrar
a his I her exaR shara oi intrlest?
It rwfre m rem�d 5 diSerent than thal of aPp6cant i�Micate bebw
a conttact seAer
'J..,. n �
or wher owner or hdder d rtprtgage
1
eY. state.
of assignee (number aM slree4 ciry. slele, and Z/P co0e)
Ooes applirant own property in any oNer I I( yes, wfiat
munrymlrW�ana? n ., n .,
20 _ � zo
Signature W CounN Auditor
numbnl
unpaid as U Martgage I ConVarl'uWebted�s ispaid as d I Is ihe app�nt the sde
Gate of appGfation legal or epuitade ame�?
❑ Yes ❑ No
If oxned with somewie other ihan spouse. indimte with whom
pn .ry in qurstion: MrwaOy Assesse0
Pfoperly ❑Mnually0.ssessed
DI'�\Y.CI' NO...Y..Y.O.•'•........
� st� �a
c��-� �o : .....................
COUNTYAUD
� 35,2-��.So
zo i �
Counry
�_
Date (month. daY. YQe�
� P��Y
❑ No
20
I I We certHy under the penalry of perjury that Ihe above arW foregoing infortnation is We and cortect arM Nat the applicant is a resident of Indiana arM
owner i contract buyer of Ne afo2meMioned property on date apPlication is filed.
�raw�(owne/sfutlname)o . n Date(monfi.daY.Y��I
FW
tlry, state,
Dy dNY �ea�tetl Power of AttwneY w M IC
Address o( auNarrzetl person (numDer aM stree; trty: state.
(month, GaY• Y��