HomeMy WebLinkAboutMortgage_Pharris"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN� C ownship Year
� FOR DEDUCTION FROM ASSESSED VALUATION
:S _- ' State Form 43709 (R77 / 6-09) 2 9 201
,.,. PresaibeC by Oepartment of Lorvl Govemmenl Fnar¢e
File Mark
�NSTRUCTIONS: C .`�.
0 6e fifed in erson or b mail with the Coun AudROr or Coun Rewrder o/ Ihe coun whe2 fhe ro o� m� �:
P Y N N ry P PertY is located.
Filitg Dates: 1) Real Pmperty: Must file dunng the year for which the deduction is sought. r� p��NTY A D County Auditor
2) Mo6ile / Manufactured Homes rrot assessed as Real Prz�perty: Must file dunng the Fv�ie r+�J %non7hs
before March 31 of each year the deduction is mughf. ❑ CounTy Remrder
See reverse side 7or additional instrucGOns and qual�fications.
AppGfam (owner�rZpnfiacl buyer - see resvir�oris on reverse sitle) � �
Key
������o�
M2a'h 1. pmmt year
..�
r.*a-�
no, what is his / her e�ct share of interesl?
name on record is dMerent Nan ihat o( appfirant, indirate bebw.
Name
Address of rtwrtgagee or mntraU seller (num6er and stree4 �M1Y, .state, aM
Name of assignee or oMer awner or hdder of mwtgage
rnoress o� assgnee �numoer ano suee4 �Y. sra�e, arw ur cooe)
Ooes appliqnt wm yoperty in anY oNer If y
wunry in I�Wiana?
❑ Yes ❑ No
Deduction a in Ne arrount oE
20 20 20
SigfaNre of CounryAUditor
I/ We certify under the penalry of
�y duty
-oo0 53�{ oa�
unpaid as af Mortgage / Contrart indeb[cdness
date of appi'icatron
If owned wiih someone
RemrE number Page number
mpaid az of Is Me ap ront ihe sole
kgal or equitade ownM
n Yes n No
Droperty in puestion: MnuaM Assessed
�al ProPertY ❑ ArmuallyAssessed
Mobile Home IIC E1.
Di•a�ver i\'O.c�Of�
what counl7/.� Wha� T 1...� 1�.J 1\iO. ..;'lJ �� �
l!
...............
COUNTY AUDiI.,.. � � `�'/ � �
20 � 20 � 20 � 20
that the above and foregoing infortnalion is true and cortect arW that the applinnt is a resident o( Indiana arM
ned property on da[e applica0on is filed.
Date (monfi. daY, l'aah
indstreef,� slate,appZlP�mdej _
�C'M J i � �„
of Attomey or Ey IC 61. id 2-0J
person (num0er arM sbeet �ry: s+ate,
Da (rtanM, tlay, yea�