HomeMy WebLinkAboutMortgage_Peach"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R71 / 6-W) ��
�' w. f Presaibed q' �epartmerd of Laal Gbvemmenl FuiarKe '\ '
� File Mark
wsrRUCnorrs:
F«m mee vrich:
To be filed in person or by mail with fhe CountyAuditw or Counfy Rewrder oI fhe county where the property is located.
Filing Dates: 7) Real Pmperty: Must fi)e dunng the year for which fhe deduction rs soughL � � Counry Audimr
2J Mo6ile / Manufactured Homes rwt assessed as Real Properry.� Must fiie dunng the twelve (12) months
6efore March 31 of each year Ne deduction is sought. ❑ County Recorder
See 2versa side (or addifional insfructions and qua/i�cafion5. _.
A1xse4 vaNe d rn�d pioperty as of
Merth 1, anent yPar
If no. whal ts his! het exaG Share Of intere5l?
-�u�-uud. z.� - i
^ Mortgage / Contract indrbtedness unpaid as of MMgaqa / CorrsaC
Mart�h 1. curtent year data of ep�6n
Ii owned vrith smrwrone UMr Ihan spouse.
Recortl rwmbu Page num6rl
O �i `� 1
unpaitl a d Is Ne appGmnt fhe sde
legal w equRade oh+ic(1
�es n No
It nartre m �emd'a diRerent Nan that o( app6�n; mdipte belovr. Is Ihe pmperty in Quwtion: Mnu�
Real Property ❑ Mnual
4AOWle
Name ot rtnrtgagee or mntract seDer '-"- '---
5 �� Drz���er\O..q���/�/ 9
AEdress W martgagee w mntraa sr�er (number and stree{ �y. sbm. an . . . . Y. . . . . . . . . .
Name of assignee w oNer owner or hdder of nprtgage r� l, ��� O. ..�.� � v/ .•
l. .....�.......
PdEress of assignee (rtumber aid saeeG �Y. sfate, and ZIP cade) �.1� LJ 5� q� S' J�
r �
Dces epplkaN wm pmperty in eny aNer I( yes. what munryl� .n ___._. utlion Ecen reques4
coumY in lnd'ena? r-1 ._ �--f1 _ I••��• •�•• � tw wrtent YeaR ��.
ez��
amounl
�
COUNTYAUDROR
20 20 20 20
c«��h � n
�
m prapeity
2�
I/ We certify uiWer Ne penalry of perjury that Ne above aM foregoing informalion is W e and corteeY aM Nal Ne applicant is a resident o( IMiana and
owner / mntraU buyer of the afo2merrtioned proDerty on date application is filed.
and
executetl Power af Attomey v by
AdOress of author¢ed person (numDer ard sbee4 �: slate.
Date (month. daY. Y��