HomeMy WebLinkAboutMortgage_Thomas (8)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 43709 (R71 / 6-09)
� / PresaiEetl by DeparlmerLL of Lofal Govemrtrent Flrenca
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wsrRUCnoNS:
To 6e filed in person or 6y maii vnN the CounryAudifor w Counry Recorder o/ fhe county where the pmperty is IocatedQ U �
Fili'g Dates: 7) Real Property: Must file dun�g the year for which the deduction is sougAt.
2) Mo6ile / Manufactu2d Homes nof assessed as Real Properry: Musf file dunng [he hvefve (72) monfhs
before March 31 of each year the deduction is srought. `-7y�
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See reverse siCe for adtlition� inslrucGms and qualifxcafions.
Appficam (owne/ armnMaC . sae iestrir�l{ on re �ide) __��''
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If name m RcoN 6 EiIIeR�ft than that o( aOP��• mdinfe bebw
Nanre o1 mat9a9ee or mntract seUer
qcaress a nmgayee «mno-aa
o�mer
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I / We certi(y uik
owner / mntraU
resident
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unpaid as of Mortgage / Contraft iMebtedness unpaid as o(
Eate of app�ption
fF awnad wiN someane othrl tlun
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Caunry
Counry Audiror
�Counry Recorder
1"t'—_'7��iC7
Is ihe property in Question: MnueM Assessed
❑ Real PtoPenY ❑ ��Y �
MoMle Hort�e fIC 6
Has Nis tletludim Daen repueste0 m poperty
for WrtCn[ YC2(� � VES ❑ I
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:r Ne atty of perjury 1he above and foregoing in(ortnalion is true and cortect and Nal the applinnt is a resident of Indiana ard
wyer o Ne atoreme ' property on date appliratlon is filed.
lr3me) _ Date (monfh. daY. Y��
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Mtlress of aWior'¢ed person (numberard saeet my, sbte, antl
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