HomeMy WebLinkAboutMortgage_Vanoven"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun r
:___ .; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 43709IR11 / 6-09)
� hw � PrrsaibeE Gy �ePaRment of loCal GOVemnrent Futance '
- File 2 2���
wsrRUCnoNS:
To be filed in rson or b mail vnN the Coun Auditor or Coun Rernrtfer o/ the coun where the ro F� �� �� �
M' Y �Y N 6' P PeMY is located. ❑C � b
Filirg Dates: i) Real Pmparty: Must file dunng Ne year for wbich the deduction is sought. un A r
2) Mobi7e / ManWactured Homes rrot assessed as Real Property: Must file dunng fhe hveNe (12J months
before Maich 31 of each year the deduction is sotght. ❑ �� �'p�7 R
oN c'�'Fir�
See reverse ' for addRional instructwns a(M qu ficatbns.
AppGant r buyer- see rawicnons on .erse side)
Ta' strir� ' Ke��ber/legald V t�on O`7 r(/o�. / /-� � RecoN�ber Page�urt)bey
p - (O �OCo
Asnssed vehie of mal p�cqerty m d Mortgage / Contraa irde6tetlnPSS unpai0 az of Mongage I Conva1Y iMebietlnrss �m�id as of • Is Ihe app6rant Ne sde
Mairh 1, almllt yPar Mar� 7. airtent yeet Eate of aOP��^ p�-/1 �egal or epuitade bwne(.�
I /��� ❑ Yes ❑ No
what Is his
If rurt�e on temtd is 6Serent tlun Nat N appBmnl, m0'uate below.
Name o1 rtqngagee w cpntract seller
w canUact
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tily, stefi. arM ZIP catle)
ooes aDdinnt wm woP�Y.in am�..•�-�
munry in irqiana?.�
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��, pra�vc,
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zo_ Carcl ��• ......� •� �o �O
sg�awre w
someorre
What Taring Disirict?
zo_ � zo
� P�OertY in Ouestim: M(wa9Y Atsesud
Real Propeity Q Mmually A55essed
Ihis dedudian Deen reVUested m prapeny
u�rent yea/? ❑ Yes ❑ No
� i �
1/ We ceNfy urWer ihe penalry of pe�ury that Ne above and foregoing infortnalion is true and cortect arW Nat the applicant is a resident of IrWiana and
owner I contracl buyer ot ihe aforementioned pmperty on date application is filed.
1�4re (owneh MI rep�) �. Date (monfh. daY. l'aa�)
IC
P4dress N aulharrsed person (numberalM sveet ary: s+ate, and LP code)
Date (monN, tlaY. YEa�