HomeMy WebLinkAboutMortgage_Simpson-""* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R71 / 6-09)
�,�,. j Prnsa�beA by DepaNmeM W Loml Govertv'rent Fuance
INSTRUCTIONS:
To 6e (led in person of by mail with the CounlyAudROr or Counry Reco,de� o/ the wunry where Ihe property is �
Filing Da[es: i) Real Property: Must fde durirg the year Jor which the deduction is saught.
2) Motiile / Manufactured Homes rrot assessed as Real Pmperty: Must fi7e dunng Ihe M1velve (12) ths
6efore March 37 0( each year the deduction is sought.
See reverse side !of �tldi+onaf inslructiio.�n-s� ��a�d qualifi�fi�s. N
Applra"t (mmer�` qY1'e!: � ref'�"'�'— �� �'1W fe1��� n .
Aswstea vanre o1 rnal yopeM1y az ot M age / Gono
Mamh i. anent year Me
Ii ro, what is h's / her era�t sl�are ot interesi?
If rwne m reootd is S�Rereni than that d app6rant hbibte belonc
Name ot rtartgag or mnveG seller
Address of rtwrtgagce or contraG se0er
Name ot asti�ee w oNer ovmer or hd
AEEress ot assignea (number aM stree;
Dces epplimM awn praperty in any oNer
munryinlMiana? ❑ Yes
DeducGOn appmved in �he amount of.
rturtgaga
stefe, and
�
—� l —��`f'��ll
�(y, ffi�,
Q
as
Year
Recorder
� � u Y� u No
If ovmeC wiN someone other ihan s7a�. udi�te weh wtom
Is IM property in question: MnuaOy As5es5e0
❑ Real ProPenY ❑ ����Y �
. 0.bdle Fbrt�e (IC 61.7-i
Ifyes.what� 7��.a,11�et. _—
L i1'0... c�(��......
Card i\'O. ....J.ra7S ......
20 _ � 20 _ � 20
� _' __ `ven re9uesteO m praperty
20
of perjury tlf� Ihe above and foregoing intortnatlon is We and correct and that the applipnt is a resident of IrWiana
orementwr� property on date application is filed.
antl streef, dry; sfate, an0
Date (monN, tlaY• Y��
Pddress o( a Wrof'ved person (numberaM sbee4 �: �+�. antl LP code)
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