HomeMy WebLinkAboutMortgage_Rains"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
� Sta[e Fwm 43709 (R71 / 6-09)
�' 1 PresviEeE M��M of Lxal Govemment Fnance
File Mark
INSTRUCTIONS:
To 6e filed in person w by mail with fhe CounryAuditor or Counry Recorder ol the county whe2 the property is located.
Filnmg Dates: 7� Real Pmperty: Must file during Ne year lor whicA fhe deduc6on is SougAL i
2) Mo6de / Manufactured Homes not assessed as Real Properfy: Must file during the Iwelve (72) months
before March 31 of each year the deduclion is mught Counry Recordw
See 2verse side 7or addrtrona/ insWCGons and qualificataons. .
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Ma�tl� 1, aaienl ytlr
ha � Fcer euG �are �f N��l?
='ia1=��°=ro -�oi. ?s4-oa
ge/ Contraa IMebtedn�s unpaid as a( Mw�qage / Contra
1, ai datc of app&ation
If wmed wiN snmmrie othe
m 2mtd is QAlermt Nan Ihat W aGP�L mdirate bebw.
mortg3gea or mntracl se4er �
of mortgagee or cantrad seAer (mm�ber and streeS �y. stefe. aId Zll
Name of assignee w othr! ovmer w hdder at mort�age
Add2ss ol asUgnee (number antl atree4 u�y, sfate, and ZIP co0e)
any oNer
DeEUC9on apprneE in ihe amount at
Zo , � _
R�s � rnA R�t,s -
=v�
ao��- �g6a
Y� u No
spouse. indxate with whom
Is ihe property in Vuestim: MnuaP� Asessed
❑ Reai PfoPeRY ❑ ��Y �
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an P�o7'ul`/
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I 1 We cerlify under the penalry ot perjury Uat the a6ove and foregoing informalion is We and correct and tha[ the applit�nt is a resident of Indiana arW
er I contracl buyer of the aforementioned property on date applicatlon is filed.
� dre (ow�efs hdl name) _ Date (monN. OeY. Yea�
of
rnY.
person (numbe� a�M sbee(, dry, state, and LP wde)