HomeMy WebLinkAboutMortgage_Mroz""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Towaship Year
; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R71 / fi-09)
� Presaibetl by Departmem W Lool Govemmeril Funnca
1
wsrRUCnoNS: 4m ed��
To be �led in person w by mail with (he Co�nryAUditor or Counry Recorder o! the county where the property is located. A U F` � � u��
Filirg Da[es: i) Real Pmperty: Must fde dunng the year (or which the deduction is soughL � Counry Auditw
2) Mobde /ManufaUUred Homes rwt assessed as Real Prdperty Must fiie dunng the lwelve (72/ months n
before March 31 ot each year the deduction is sought. `-Yr� µ I�:,���nty Remrder
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See reverse side lor addrtronal inshuctions and qualificafions. V �
l,4p/p/�ra�nt (owner a c1ont2p 6uyer � see resfn�lions� reverse sitl� �/ � � �y�� �
i 1-J1 11L/1.7 /r� /�_1/� / �'% Gl�iLiCi� `/ I`� `"� 'Y
� �V/berl��d /hay' �V `(�O ^ T Recore� O � Pag� �
8 �J' OC V
property a d Mwtpage / Contraa intlebtetln¢ss unpaid as of Mortgage I Contrac[ mdebte0nes5 unpaiG as d Is Ihe appOfant tlx sole
Ma�ch 1, wrtent yrar tlate of appGCatim legal or equitaNe rnmeYt
. Q y Q �� ❑ Yes ❑ No
r.xart �ara ot intemst? If owned wiih sameone dher ihan spw�se. i��ate weh whom
iRe�ait Nan ihat of app6wnt, uidicate be6ovf � ne vem� �n aues�m: n.��aor nsse�d
e HvPeKY ❑ %vm�a�YA�e�
Name of mvtpagee or contrarl se0er
Address of mort9a9� w mntran se�er (num6er st
Name of assignee w other owner or hdOer of rtqrtgage
Maress ot assignea (numDer aM s7ree4 �; �ta. enc
Dces applinnt own p(operty in any oNer
munry in IrWiana?
❑ Yes ❑ No
D�ucfim apprwad in Ne artqunl of: -
:e( rdy, s
LP code)
If yns. what counp? � YMa� Ta�dn
20 _ � 20 � 20
Sig�anue
I/ We ceNfy urWer th�enalry of perjury
owner I mntract buyer of ihe afwemerrtic
YFull resident adtlress of appGnnt (number and sLeet. riry,
18'Uz SoJ++Z n� n S t.
Psvon auU�naed Dy dWy ezecutetl Powu of Attorney w 1
20
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D1'a\\'Cl'\�..••••O —
Cal'd NO. ..`�g�........
� I [�`-�� DO . UD '
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Date (rtbnth. daY. Y��
20
a6ove and (oregoing infamaGon is We end cortect arid Nat the applinnt is a resident of Indiana arM
�erty on date appliration is filed.
Date (�W, Eay, yaa�
person (numbe� and sbee( dry, stafe. aM LP code)
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