HomeMy WebLinkAboutMortgage_Priestly"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T shi r
__ FOR DEDUCTION FROM ASSESSED VALUATION
� Stata Fortn 43709 (R71 / 6-09)
S � Presofbetl by Department of Lacal GovemrtreM Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor or County Recorder ot the county where the property is locafed.
Fil'ug Dates: iJ Real PropeRy: M�st file dunrg the year for which the deduction is soughG Cou ry Auditor
2) Mobde /Manufactured Homes rrot assessed as Real Property Must fi7e dunng the hveHe (72� months �
before Ma2h 37 0( each year the deduction is sought. ^� �
f��g i
See revarse side for addifional inshuctions arM qualifications. .. GISSdM' A
I AppGqm (m7�e�or mnoarl6uyer-�See ms�icbon.�m re�erse stle)
Distrid
Assessed ralue d real aapstY as ot
A1afU t, arrrlrt yrar
rc ra. wnat Is nis I rrer rsaa share or interesl?
fhan
�er / legal desaiption
-�1� ,�� C�O�
Mortgage / Cantraa intlebtetlness unpaid as
Mart�h 1. artent )mar
IA �� 1� ��
ot rtwrtgagce w mntr�cl se0er (number aM street rity, sbm, arW
Name ot azsignee m othu awner or holder of mortgage
ACCrPSS of as9gnee (num0ar and atreet, cdY. slete, eM
��
Dr�uction approved in ihe amoum ot
�. �� ���
20 _ � 20 _ � 20
�nt Na sole
�itaWe amM
Yes ❑ No
spouse. Gd'�mte wiU� xlwm
pfopeM1y in Oue5ti0n: MnuaDy Assessed
�I Propertv ❑ /vmua�N assessed
Drawer i\`O. !,�,`_]�''�
.. "`•-.1......, -
Cal'd 1�'O �i��� -
�,T��a $(�2,155�.�aj' .......... ,
20— � �— � p—
Date (/mrRh. daY. Y��
r.i� ��
I/ We certify under Ne penatry of perjury Nat the above and foregoing infortnalion is true and mrrect arM that ihe applirant is a resident of I�iana aM
owner f contract buyer of the aforemeniioned properry on date applinlion is filed. .
dry, state, and ZIP code)
Dy dWy ezecuted Poxer of Atlamey w by IC G7.
perv�,on (number aM snae; ciry, stale, axl ZIP code)
oa�e (�nn, aer.