HomeMy WebLinkAboutMortgage_Moy"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun hip r
r__ : FOR DEDUCTION FROM ASSESSED VALUATION
. • State Fortn 43709 (R17 / 6-09)
�' ,w I PrraiGetl by Depanmerd of Lowl Govemment Fuance
�STRUCTIONS: �^�
To 6e filed in rson w b mail with the Coun Auditor or Coun Recorder of the coun where the io F� �� �
Pe Y �Y b �Y P PeRY is located. n
F�7ing Dates: i) Real Property: Musf file durirg the year /or which fhe deducfion is soughL �� M����
2� Mobile / Manulactured Homes rwt assessed as Real Pmperty Must file dunng the hvefve (72) months �❑ �
befo2March3fofeachyearthedeductionissoughG GI OIVGOUNTY R er
See 2verse side for�dHt�ional instrtrclions arM qual fcations.
Appfram(ow4erm tra bjy2�-seeresv9:lions ve sife)
�
�
f real VoPe*ry az
'�
If �w.
v�.«lii�
It name m 2mN is ddfuent ihan Nat ot appfwan4 ��� bebw:
Name oi mortgagee W mntracl seller
«rnno-aa
Oces applinnt own pmperty in any aNer
counry in InCiana?
❑ Yes
Y��
awn0er arM shee4 ciry. t�afe, arN:
�� m �„myaye
cdy, state. antl ZlPOOde)
I( yes. wfat munry?
rn� }"�D�
ia-� ��
20
RemN numbrl Page num0er
�a . ii- 6a�'
as of Mortgage I Contraa indeMedne,ss unpai0 az of is Me app(rant Ne sde
Oate of ao(�� --1 �egal or eqUitable awneR
O�C r a i ❑ Yes ❑ No
owned vrith someone dher than spouse. indirate wlh whom
Is P�P�Y in QueSUM: Mnually Assessed
Real Pfoperty � AMUally A55CSSed
What Tauiy DisVid?
20
Has ihis dedutlion Oeen
(or wrtenl yeaR
20 _
Dale (rsronlh. day, yea�
O�rtY
❑ No
2� _
I/ We certify u�er Ne penalry of perjury Mat the above and foregoing infortnalion is We and cortect a� that the applipnt is a residerrt of IMiana arW
owner I wntract buyer of �he a(orementloned property on date applin0on is filed.
fnahrtnfowne/s IW remel Date (monRi. daY. Yea�
Pem.on auNwrzetl
IC 61.
Pdtlress of auNOr¢eE person (number aM sbee4 ary, sb(e, and LP code)
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