HomeMy WebLinkAboutMortgage_Pottorff"'� STATEMENT OF MORTGAGE OR CONTRACT IND BTEDNESS Coun
_ FOR DEDUCTION FROM ASSESSED VALUATI
• Sta[e Fomf 43709 (R71 / 6-09)
�' »�. l Fresrnted by oepanmeN at tnd Gwemmerit Firence
INSTRUCTIONS: � �
e
To be filed in person or by mail wifh Ure CountyAuditor or Counry Recorder of the wunty where the � i
Filirg Dafes: i) Real Pmperty: Must file dunng the year fir which (he deducfion is soughf.
-2J Afo6ile /Manulactured Homes not assessed as Real Property: Must file dunng fhe Iwelve (12) mC�s, C
6efore Ma/ch 37 of each year the deduclion is sought. Q ��
va � e(or addi[io I st/ucfiOns and quali�ications.
( er C ti r on reoe �
I� �' .� o n,�n� /1 �,n A �ry�
����
...�'�'.u'.I
Contrati inCebteEness unpaiG as ot Mw
irtent OO^ dao
U
If ovmcd wiN
�
Name ol mortgagee or mntrad seller �
Adtlress of rmyagex or mntraa seDer (num6er and stree4 �1:
Name of assignee or other owner or hdder W rtqrtgage
IIpN am
Indana?
Deduction appiwed'u� the amount of.
20 _ 2(
�naNre U Counry Audi� _
I/ We certifv urWer i
n�aeo� o� p,n
Person autlioraed Gy duy ezi
Pddress of aulhaved pei ,on
5/8ffi, eM Lf' mtle)
If yES. MfiBt fN1111�1
I No
What Tad�g District7
_��I_ 20—_ _
_ a�0�.......
ra"c` �0 ,,..•
➢ y���-..••••
�O ,.
C�l d �� �p —
� ,�, � J'nnce�
...umeY a M IC 61.142-0]
nr arM sbee4 uty. state, and ZIP oode)
Counry Auditor
Counry Recorder
I le9al a ewitable ovmef?
❑ Yes ❑ No
spouse, iMi�ate with whom
Is Ihe pfoperty in 0���: �nua0y Assesse0
� Real ProPeNY ❑ ?�!���a�Y � . . _
Has ih"s
FO� WfR
on pmperty
❑ No
20_ 20_ 20_
Date (month. day, YEa�
and corted and that Ne applirant is a resident of Irdiana aM
7
Date (