HomeMy WebLinkAboutMortgage_Seale (2)Q�
^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ � FOR DEDUCTION FROM ASSESSED VALUATION
�• State Fwm 43709 (R71 / 6-09)
�` Presaihed by DeparimeM of Local Govemrtrent Firenca
u�
INSTRUCTIONS:
To be filed in person w by mail with the CounryAuditor or Counry Recorder of the county where the property is located. F
Filing Dares: 1) Real Pmperty: Musf Re dunng fhe yearfor which the deduction is soughL � ���O��d��
2) Mo6de / Manufactu2d Homes not assesced as Real Prz1peerty: Must fiIe dunng the hvelve (72) months C�.,.,_
6efole March 31 0l each year the deducfion is s�wght ��d�
SeereversesidefaaddrfionalinstructkronsaMqualificafions. n Glaen.�,.,.._ \�
tt no, what is his l hu e�
tl na11�B on �eNltl 6 E11f¢!Pf
em tl
Name ot moRgagee or mntrarl seller
AdAress of mMgagee or mntrad seAer
Name of assignee w other awner or hd
AEdress of asvgnea (number and stree
pvm property in any oNer
a� ❑ Yes
De�ucfim approveE in ihe amoun[ af.
- U—V - Uv - v - v v_ Uv-i V
Mortgage / Cantrarl(nde6letl(ress unpaid az W Mort9a9e I ConYact'vMebtedness unDZiO as of
Ma�ch 1. artent yeer date of appfi�tion �
est? If owneE with someone oNer Ihan . irid'xate wtth wM
aPP��L mdicale belo'�' Is propeRy in Questit
Real Property �
�/�
n aMsvaef,fny,state,aMZlPcode)
mortgage /
� CJ
s!ale, antl ZlP coae)
I( yes. what county.+
No
v��
Wh3t Ta�otg D"sUitY?
COUNTYAUDROR
mnt the sole
ritable owner/
Yes ❑ No
AssesseA
lssessed
me (IC 61.
Has Nis dedu�lirn Deen reQUesteE on P�Y
Nr wrtent yr,all ❑ Yes ❑
20 _ 20 20 _ 20 20 ��----. __�,__ 20 _ I 20 _
�13�.J��` -�`_` --
Sig�uDUe U CamtY Auditw Counry �_ .
llratir•er �\'O,o101 -
I I We certify uMer the penalry of perjury that Ne above and toregoing intortnation is we and ••••••..°.�, ,,�. d
owner I wntract buyer of the afaementloned property on date application is filed.
� Signature (awne/s M1dl+iame Ca �-(�
1\'O. ..;..
FiA �Eent etldress o1 appGcant (num6eraM sfree4 mY. �te, entl ZIP ootle � :. l� •• •• �• • • • • • • • —
) � o� <J� Q�O
� 5/d� 5. 3 ow. cjw e s'(� � �{7 �05 _
Prnm auNa¢eE by tluty executed Power of Altort�eY w Dy IC 61.1-12-0.7 Date (month. day, Yea�
per:m (num6erarMstree4ciry.state,aMZlPCnde)
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