HomeMy WebLinkAboutMortgage_Sheppard"'n STATEMENT OP MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year �
-, _• FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Form 43709 (R77 /6-09)
�` yµ f p�e�y� py pe�yrtment of local Govemment Frerxe
File Mark
INSTRUCTIONS: �
To 6e filed in person w by mail wifh Ihe CounryAUditor or Counry RecoNer of the county where Ihe property is loca�j �
Filirg Dafes: 1) Real PropeAy: Must file durrng the year (or which the deduc6on is sought d'� ry ditor
2) Mo6i7e / Manufacfured Homes not assessed as Real Property Must file dunng the hveNe (12) mo/hhs
befo�e March 37 oI each year the deduction is snught. County RemMer
See reverse side for additbnal instmcGOns and qualifications. S E
Applicant (owneref confract buye�- see 2sfrictiuns m reverse sitle) _ .
c.�.n��
Ta ' �istrirl _ K v mber / leoal Aesaiotion Remrd number�! ae numbu
o�lp "/d - 7-
Assess¢d vdue d real pmperty o( Mortqage / ContraG u
Mardi 1, aarent year Mart� 7. artent year
If ro, what is his ! her ewct share of inlrRSl?
If nane on remrE is tlitfuent than that o( appfxan4 mdirate Gelovr
Name of mortga9ee or
Address of rtwrtgagee w contran
awner or hdder of rt�ortgage
slate,
Add2ss of a ee (number and stree4 �'. state, aM ZIP code)
,�"T F ,a-
Does apd���� � P�PenY in any other If yes, what count}?
counrymindiana? n .,__ n .,_
Deduction
20 _ � 20
Si9r�atlue
�
u unpaid�of Mort
date
If ovmeC wkh
, 8,3
What Tatlrg �u
OUNTYAUDROR
20
indeb[edne5s unp3id a5 of Is Ne appircant !he 5ole
legal or equitaWe wmM
QQ� ❑ Yes ❑ No
spouse, indinte wBh wlwm
Is tlre pmperty in question: MnuaOy As.^,esseA
�r£eai �o�env ❑ a,�ua�ry a�s�ed
Dra�ti�er NO.... ���a —
• ............. Y
c�,��.�o......`-�%%S Na
.............. —
��I I�.� —
2u � _ _
Date (rsnrCh. daY Y��
1 I We certify under Ne penalty o(�perjury that e bove and foregoing intortnatlon is We and cortec[ arW that the applipnt is a resident of Indiana arM
owner / contract buyer of the aforemerrooned perty on date application is filed.
Signa � (owners MI ) � (��, daY. YBaA
fullfesiEe tlressoapMrant(number t, s7ate,ardZlPCatle)
:i62 G C.e/5v S !'ince� /N'�7�70
Person auNOrized by OWy executed Power of Ntomey or by IC G7.7-12-0.7 Date (rtanlh, tlay, yea�
of authoraed pe5o� (number and streef, dty, shdte, and LP cmle)