HomeMy WebLinkAboutMortgage_Mull"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
,_ � FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 43709 (R11 / 609)
�' � Presuibetl by Oepartmenl of Local Govemment Frence
' k
INSTRUCT70NS:
To 6e �led in person w by mail with [he CounryAuditor or Counry Recnrder o! fhe counry whele the pioperty is located. D� fl� ��:
FiI'ug Dafes: 1) Real Properry: Must fde durirrg the year for which the deduclion is sought ���p�ditor
2) Mobile / Manufadured Homes rrot assessed as Real Property Must file dunng the hvefve (72) months
6efore March 31 of each year the deduclion is sought. ❑ Counry Remrder
See reverse side for adtlitbnal insvuctbns arrd qualificatbns.
Inppfram rwmnhap ns m.urprtions reversesitle) COUNTY AUDITOR
F C2��2, 1� l/
�' T Distrip Key rupnber / legal G�, -�. 9� �- oa� Reco(d numbv Page num0u
0
A�sed rahie d real V WertY as d Mortgage / Contraa 4dehtedn�.s unPaid as of Mortgage I Con� udebtedness �mCaid a d is the ePP��t the sole
�. Mart3i 1. aa�ent year Martl� 1. airtent yrar Catc of aPP��� n /�� legal w equitade ameR
"/ QL/v ❑ Yes ❑ No
IIi no, what is his / her exa�i share o( interesC+ If owned wiN someone other Nan spouse, indicate wiih wtwm
It name on rtmd'S diRemrt Nan ihat ot appWanf, md'uate hebvr. I5 property in Question: MnuaOy PssesseE
Real Properry ❑ MnuallyAssessed . . _.
Name oi mongagea « mntrau
sneeG uA:��.
of azsignee w oNer awner or hdder of mortgage
AEdress ol asvgnee (numDer and stree; �; stete. and ZIP tode)
Does applinnt wm property in any oNer I If yes,
munry in InCiana? � �,
2�
Sig�anne
�_ , �
NRat Ta�dtg Dishic
COUNTYAUDROR
zo �
D��z„ ��-.o.....a�o�.....
C:1CC1 \0. ...`J`��.........
`� 3�, D50. 6D
- i � i 20-
�Y Yee�
I/ We cert'rfy urWer ihe penalty of pe�ury that the above arW foregoing infortnation is We and mrtecl arW Nat the applinnt is a resident of Indiana arM
owner I mntrac� buyer of the ataeme �oned pm rty ate application is filed.
Inah�re (ownefs rertrel trate (� daY,� �
\�n„�,�� iJ/ 3/ a 9
6
ezecutetl Power of Attorney or by IC 61.142�]
Pddress of aWior�d person (number and sfree4 ury. s�ate, an0
�o
Datc (monN, daY Ye�