HomeMy WebLinkAboutMortgage_Reynoldsp� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
• FOR DEDUCTION FROM ASSESSED VALUATION
. • Slate Fortn 43709 (R77 / 6-09) .
�' E Preuribetl by �epartmeM ol Loral Govemment Fnance
�TRUCTIONS:
To be Red in person or 6y mail witA the CountyAUdito� or Counry Recorder of the counry where the property is located.
Fiiing Dates: 7) Real Pmperty: Must fi/e dunng the year (or which the deduction is sought.
2) Mo6i/e / Manu/actured Homes rwt assessed as Real PropeRy: Must file dunng fhe hveNe (72) months
6efore Maich 37 0/ each year the deduclion is sought.
See reverse side lof adtliWnal instrucGOns and qvali�cations.
AppGram (oww or d buyer - see on rcverse side)
/ /
�i'—
T � � ber/IegalOesaiption
�t_ , „__,�- -ao3- 4 -o
w�,ea �rah,e d re� aopenr as a I Mortse9e
Ma�tl� 7. mmnt Year MarM t,
H ro. what is h511w1 e�ct shara of interest?
If name on mmd is dAterrnt lhan �hat o1 applicant i�Mifate
Name of mortgagee or conttacl se��ern. �� �
Name ol assgnee w oNer owner or holEer of morigage
AdCress ol assignee (number end stree4 �++Y. �te, ard
Oces apdiraN oMn P�PenY in anY other
JUN 11
Counry AudBOr
County Recwder
Contraa IrWe6tetlrress unPaitl a d Monga9e I Cortvafl' eCtedness w�Gaid as of Is ihe ePG��nt the sde
�� � Eate of aPP�tion 1e9a1 w e9u�61e rnmeR
❑ Yes ❑ No
If owned with snnieone ocher ihan spouse. iMicale witli wlwm
eww. 15 me wucem In auestion: a,nuaM assessee
.r.if2eal RoPertY ❑ MnUally Assessed
7" Modle Home OC 61.1-1
state. ard
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�Y�,��.s� 0�'B� �
ia-a� ��
y�o
� 20 �_ Zp_ _ [0— 20_
��ranrte of CamN AuCitor Counry Date (monlh, daY. Yea�
I/ We certify under ihe penalry oi perjury Nat ihe above and (oregoing intortnalion is true and mrtect and that the applirant is a resident of Indiana ard
owner I contrad buyer of the afo2mentioned property on date applicatlon is fileE.
Address of auNw¢ec Cerso^
� t, dry, sfate, and ZIP m
of Anamey or y IC G7.142L.7
'sbeef, dty, sta[e. aM Z!P code)
Date (monlh. EaY.