HomeMy WebLinkAboutMortgage_Perry (3)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
_. ; FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fortn 43709 (R11 / 6-09)
�' f Presaibetl Oy Oepartmenl af Lnral Govemment Fnance
� INSTRUCTIONS: � e erk
To be filed in rson w b mail wiN the Coun Auditw or Coun Rernrder o/ the coun where the ro ���'
Pe Y b' N tY p perty is locared.
Filing Dates: 1) Real Property: Must file dunng fhe year lor which the deduction is sought. � Counry Auditor
2) Mo6de / Manulactured Homes rrot assessed as Real P�operty: Mus! fiie dunng Me hvelve (12) months
before March 37 of each year the deduclion is soughG S� �oun�{�Order
See reverse side for addifional instruclaons arM qualifirations. (, ,�
Appfira�l (owne oontracj�buyer- . on lever.�e sidki l\ \
FZ'�"J
'V l� ^ �V�•
MMga9ej/y CQoenntr[ay�tl rt/d�e6teEnesS w
M2ttl� 7�/)�1 —1 l D• O V
tt rartie m recwE's tliRerent Wn that ol aDpGpnt,
Name ot rtqrtgagee or mntraG uller
Pddress of mort�agce or contraU se�er (numDer end stree; rity, 5afi, aM ZIP aode)
Oces epplirant own property in any oNu
munry in Ind'ana?
❑ Yes
Dr�ucrion approvad m itre amount ot
20
Sig�tlire W Cotmb AuEibr
s�afe,
No
20 � 20 —
r0,�
T
as m �
rc owned wim sorneone ourer Can spo�se.
Whal Taurg Distritl7
COUNTYAUDROR
20 20 _
Caunty
az d ( Is Ne app�ant Ne eN°
kgal w equitade awneR
❑ Yes ❑ No
Is ttie DroDeRY in OuesOOn: MnuaM Pssessetl
❑ Rea� �oPeny ❑ am�,�ny a�sessea
0.lohle Home (IC 61.
Has Nis detlutlion been requested at propeny
for cu�rent year? ❑
❑ Yes
20 � 20
I/ We certify under the penalty of perjury that the above and foregoing infortnalion is W e and correct arM ihat the applinnt is a resident of IrWiana aM
ovmer I contract buyer ot ihe atoremerrtimed pro0erty on dffie applira0on is filed.
Pe�SOn
sLeef, dty, state,
Ey Ouh/ executeE Power N Attomey
per5on (num0e� eM street �/ty, state,
7
Date (rtonth, daY. Yaa�
Date (monlh. tlaY. Y��