HomeMy WebLinkAboutMortgage_Staggs"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
:,,—
s FOR DEDUCTION FROM ASSESSED VALUATION
�� Stale Fortn 43709 (Rt t/ 6-09)
S � PreSaiGed by �epartment o( Lotal Govemmenl Finante
� File Mark
INSTRUCTIONS:
To 6e filed in person or by mail with Ihe County Auditor or Counry Recorder o/ the 000nty where the ploperty is located.
Fi/ing Dates: i) Real Pmperty: Must file durirg Ne year Por which the deduclion is sought.
2) Mobile / Manufacfured Hames rat assessed as Real Prdperty Must fi7e dunng fhe fweNe (12J months
before March 31 of each year the deduction is sought.
See reverse side for additional instructions anC qual�cations. G
I MP�'d4� (owner armntrdC buYer - see m_ctQqbn,s m reverse side) .. 1 /_ �
C
Ta DisbiU Key numDer / legal desaipUOn /� Record number P e nu
iz,��rr� a6 -ia -�- o/- 000. 8iv-o a8 �Xa/i �s
AsesseG vdb�e ri real poper,Y as o! hbrtgage / Contraa'udMtedness unGaid as W Mortgage / Cmtract intlebiedness unGaid as d b Me aCP�� tlre sok
Ma�di 1, anent year Mamh 1. a�rtent year Date W ap�&ation legal a epuitable o�me!?
❑ Yes ❑ No
ro, what "s his / her e�ct share of intrlest? If owned with mmeone other ttan , iMirate wiN wtnm
If name m recwd's diHerent Nan Nat of appGCant, cWipte 6ebw. Is ihe propeny in puestim: Mnua�y AssesseC
P21 PtoPertY ❑ ���Y �
Mohle Fiort�e IC 61.1-7
Name o( rtartgagee or mntraU seller
�y'l�i �i�a�,.� _ �
A4dress of rtnrtgagee w cantrad se0er (number an95t
V
Name of assgnee or oNer owner or hdder ot rtwrigage
ACtlress oi as4gnee (number antl street �+N. ��e, anc
L� E !�� a� 1
Ooes appliqnt own property in any other
munry in IrWiana?
❑ Yes ❑ No
DeCUCUOn apprwed in Ne amount of:
20
Sigfa¢rte of Coimb Aud'aor
�� _T. -
I/ We certify under th�
owner / mntracl buye�,
�d� S. N,1r
Person auNOrrzed Gy tlWy ex
20
penaliy ofberjury that
of Ne a(wementioned
e4 �ly. smte. aM ZIP code)
'IP e)
�.,��'� ��
Whal Ta�d�g Disinct? Mas Nis deductim Deen reQUe��d'
(m wrtent Vra/�- �
COUNTY AUDROI �q� 1 1 _
V
j ......
Dra��er \0....��� —
20 20 ��7
Counry C`dC(i �� . .............•�•; •`'i �SC/—
��� ` �� � �19 ID4tJ
' �`� ,
h hove anC foregoing infortnation is fiie and cortect arW that the appli�ant is a resident of Irdiana and
perty an date appliwtion is filed.
� Dace (morvh. daY. Y�h
sf3fe. ard LP aotle)
of authaaed person (num0er antl sUeeG crty. sfafe. and ZlPmde)
Date (monlh. EaY• Y��)