HomeMy WebLinkAboutMortgage_Naas (8)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun s' ear
__, � FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R71 / 6-09)
�\ l PresaiEed by �eDartment ol L.oral Govemment Fnance 1
NSTRUCTIONS: J� �
Fwm flad wiih:
To be �Ied in person or by mail vnth the CountyAuditor or Counry Recorder ot the counry where the property is located. � 2q j�Cy�p,
Filirg Dates: i) Real Pmperty: Must file dunng the year for which the deducfion is soughL J�❑yl ~('�� lY'�SSdimr
2/ Mobde / Manufactured Homes not assessed as Real Property: Must fiie dunng the twelve (12) months
be/ore March 37 o(each yearthe deduclion is soughG GIBS N CIIIINTY AUD �er
See 2verse side for addrfional instructions arM qualilcafions.
Asessed rahre d real DmpertY as of
Mach 1. Nm1M1 year
If ia. wha� is h's I her exaa dare of inferestt
- - /o/-O 0 �. 0
'lAOrtgage I Contraa irdebteCriess unpaid as U
March 1.arten�year
If owneC
recad's tliRerent Nan thal o( appG�ant,
ot mrtgagee or mniraa
AEdress of rtnrt9a9ee or mntrari seAer
Name of assignee w o�c owner w hddg of mort9a9e
Mdress of as�gnee (rvmDer aM snee4 �=Y. sfafe,
rdy, slate, anG
WhaiTa�d�g
� p�-1,ti ��- vo......�.L�.t�.....
� Card �ro. .....3y58
�o i � _
rwmEer
mdebteeness unpaid as d
spouse.iMicate
itaGe mmeY.�
Yes ❑ No
c propeRy in Question: Mnuelly Assessed
rxea� arocem ❑ ,4r,m,a�y nssessea
Has Ihis detluUion Deen repuesleE on property
for curtent yeaR n Vn_s ❑ No
�_ i zo_
o�� c,�r,,. c�r. r�se
I/ We certify under Ne penalry of perjury that Ne ahove and foregoing intortnalion is We and cortecl and Nat che appli�ant is a resident of Indiana aM
owner I contract buyer ot the aforementioned property on date applicalion is filed.
,.e At,.,.,e.t na,.��,oi /l Date (montb. daY• Yaa�)
� Fuli resident adtlress of appGcant (num � C st�eet, tlry,�te, arM ZIP ca
/3 �. � �
Person aut7m(rzed Ey Guh' ezecuted Power of Attorney or by IC G7.1-12�.7
lbtlress ot authortrcd persm (numbelaM sbeeG dry. state, and ZIP code)
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�E'lli�tl �///- c�967�
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Oate (monlh. OaY. Y��)