HomeMy WebLinkAboutMortgage_Johnson (19)'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ , FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R71 / 6-09)
�' 1 Presaibad Dy Department af Local Govemrtreni Frence
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INSTRUCTIONS:
b 6e filed in person w by mail wifh the CounryAutlitor or Counry Recorder of the county where the property is bcated.
Fi6rg Dates: 7) Real Property Must file durirg Ne year /or which (he deduclion is sought.
2) Mo6Ae / Manufactured Homes rat assessed as Real Property Must file during the twelve (12) months
before Ma�ch 37 of each year the deduclion is sought.
See reverse side lor additional instructions arM qualifications.
AppGCant( rormn buyer-se mre side)
�
I T�JC�,��c. • -/�d�tl�� Uo �'�1D a. �oS�-o i�
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t, aaant year
If ro. wha� a ha ! her e�tl share of interat?
an remtl "s dtlfrJent Wn that o( appapnt, trdirate bebw.
f mort�agee ar mntraa seller � �. .
ACdress of rrort�Ja9ee a mntracl se0er
Name of a5s�ee Or oU�er ownet Or holder of `mrtgaga
MCRSS ot assignee (n1unDB/ eM Street �y. stale, an0 Z/P coda)
unpaid as of Mwigage / Contract'v�debte
vriM sorneorre
� /��Q
ty fn any aNer I I( yes. wha[ muntyt I What Tadng DistriG7
Cl_ves ❑ Na
Year
° �� v ObU�� quditor
�. ��Cnunty Remrder
��
ritable owneR
Yes ❑ NO
sPO��. indirate WM whom
IC P�G�Y 1I1 GYESbOfI: MIIU2MASSGSSCE
Real Property ❑ AmuaOyAsscssed
/ S�S�A e
� v�a�i
vl":11YC1' �i�...�O.��f-.....
20_ 20 20 20
c���� .�o. ....y9i!s . — — —
p Caunry Date (rnonfi. daY. 3��
� 1 ()a��.�
I/ We certify under the penalry of perjury Nat ine aDOVe and foregoing infortnatlon is W e and correc[ aM that Ne applicant is a resident of IrMiana and
owner / mntract buyer of the aforementioned property on date application is filed.
�nawreso�mrera�xm imrm.l 1 /I �ate (rrorw. dar, r�tl
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Power af AnomeY or by IC 61. t-12-0.7
person (numDerairo sbee4 dry, sYdte,