HomeMy WebLinkAboutMortgage_Sisk (3)_"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
FOR DEDUCTION FROM ASSESSED VALUATION
- • SFate Fortn 43709 (R71 / 6-09)
S y�. PrgrnbeG by DepaRrtieM oT Loral Goremment Fuance
wsrRUCnoNS:
To be filed in person a by mail with (he CountyAuditof or Counry Recorder o/ the county where the property is loca
Filing Dates: i) Real Property: Must fde dunng fhe year /or which the deduclion is soughf.
2) Abbde / Manufadured Homes rwt assessed as Real Property Must 61e dunng the lwelve (12) months
befwe March 31 of each year the deduclion is sOUght.
See reverse side foi adtlitional instructnons and�ualifica�ns. n
nppicant(o mppaabyRr-s� reverse "e) - ,
1 mal ptaperty �
Y�
artent yeer
tl name m remd'6 dirterent than that o( aPP��t indicate bebv`
Name W rtrortgagea m m�traU seAer �
ACtlress d nnrtgagee ar mntrad se�er (number and slree4 �Y. sate. e
n Coucyypp,uditnr
� '� �UW
L'J Caunry Recorder
7e I Contraci indebtedness unpaiE as d Is Ne applirant Me sde
appWation legal w equitade ownM
❑ Yes ❑ No
If ovmed wiN sorneorie other Ihan spouse. 4Wicate with whom
Name ol assignee w other owner or holCer N mniqaoa . ---
Address ot assi9�ee (numbe� and sbee4 �: sn �'^� /�r` �' R 5�
oces epp�nt own woPem �n any omd
muNy in Ind'afu?
❑ Yes
DeOuction apyweE in ihe amount of:
r
D�i -�8► :
Is Ne property in question: Mnua�y Assessed
❑ Re� a�v�rty ❑ a,,,uany w�d
- � ��--�
- � �
- �_�-I-c� �
�
� No
20 20 20 _ 20 20 / _
Sig�Wre N Camb Auditor Counry —
/
1 I e certify under the penatty of peryury Ihai ihe above and foregoing infortnaUon is We and mrrect anc � 3nd
ner I contraG buyer of the aforementioned property on date appfiration is filed.
rawre rnehfuArem/1 , . 1_ //
authoiaeE by OWy
ciry, stafe, aM
(numbe� arW sfreet, dry, state, aM ZIP mde)
�