HomeMy WebLinkAboutMortgage_Renfro"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ -� FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 43709 (R77 / 6-09)
,,�,. 1 Presaibetl by Deparlrnent of Laral Govemment Flnance
p, ' Mark
INSTRUCTIONS: �'
To be filed in person or 6y maii wiN the County Auditor or Counry Recorder of the counry where" e property�o'Jcat . �
Fil"mg Dates: i) Real Pmperty: Must file dunng the year for which the deduction is soughf. �unry Auditor
2) Mo6i1e /Manufacfured Homes rwt assessed as Real Property: Must file dunng [he twel��(1p) �nQsZ o0
6efore March 3� ot each year the deductron is sough[. ❑ County Re�der
See reverse side for adtlifional instructions and qualficatio _� ���
iAppfirant(ownerwmnfiarl6vye�-see reverse /�'l6�.v
�n in
Oistrict Keynumber/I g desc�ip' Reco(dnum Pa9en bu
a-� �-� a�-r�o, �pJ-o� � 9 a�,'
IAs¢sed vdue d real property as of Mortgage / Contraa indebtedness unpaid as of Mortgage I Contrarl indeMedness unpaid as d Is ihe applinnt the sole
Ma�tl� 1, arrnnt year Ma� 1, current Q' date of appGCatim �egal or equRable ownM
�u O O O ❑ Yes ❑ No
fl( no, what's his / her exarl �are ot intems!? If avmed with someorre other than spouse, indirate wNh whom
It name on 2mrtl's tliRerent than Nat of aDP��4 �Cinte Eelow Is Ne pmpetty in puestia�: Mnualy Assessed
❑ Real Property ❑ Armualy0.55e��
� blobile Fbme QC 61.7-�
Name of mortgagee or convact seller - yJ
/7 //
U� K_ il.,
IAddress of mortgagee w contraC seAer (number aM stree; city, smfe, aM e) —
IName of �" �nee w oNu ovmer or hdder M mwtgage � �—
AEtlress ot asvgnee (number aM street—� � Q� , , , . . . . •
Dra���erNO•� • i .
Does applinnc ovm property in any oNer � ,I ^ ^ 2 Has iha deduGim been requesteC on proprJty
munryinlndgna? N�./.✓. �....... forwrtentyeaY? � Yes ❑ No
❑ Yes �V�V`, •
C�t'd ��• .....
� � 5�,�00� `�'/
DeducGOn app�oved'n Ne am�unt oY. -�
20 20 20 20 20 20 20 _
Sig(ature of Counry Auditor Counry Da�e (rronfh. tlaY.7'ea�
I/ We certfij untler �he penalty of perjury Mat the above and foregoing infortnalion is We and cortect and that the applinnt is a resident of Indiana arnl
owner I contract bu e aforemefrtioned property on date appliration is filed.
Si9naWre (o h/utl nam ) Date (rtionth, day yea�
ov
' ull 'dent adtl ap�nnt (num r arM sLeef, dty, sfate, arM ZIP code
b q �. eF�cv sa�►� 2� h c:�.� � �-{�1 LeS1,0
Person autlrorized by duly executed Power of Aaomey or by IC 61.1-12-0.7 Date (monlh, Eay, yea�
Address of authaaed person (number aM sbeet �Y. slate, aM LP code) .