HomeMy WebLinkAboutMortgage_Fuller�"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year •
7__ � FOR DEDUCTION FROM ASSESSED VALUATION
:� Stata Fwm 43709 (Ri1 / 6-09)
�` , PresaiCetl �y Departrtrent of Lacal Govemment Fnantt
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INSTRUCTIONS:
To be filed in person or by mail wifh the CountyAUdito� or Counry Recorder o/ fhe counry where fhe property is located. �
Fifrrg Dates: 1) Real Pmperty: Must file d�nrn� the year fir which the deduclion is soughG � Coun r
2J Mo6iTe / ManuFactured Homes rrot assessed as Real Pmperty Must file during the twehre (72) monNs
befoie Maich 37 of each year the deduction rs swqht � EPC� 1�W1bf Recorder
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See reverse side /or addifronal instructions and qualifications. C.'1 m--,4_
App6c�nt(owrarmcontrar�bu�seeresfric8onsmre�xrseside) . . � � (`��`j
Ass�ssed vdue d aal paperty as d
Mardi 1. aa�mt Ymr
1f fq. Wh31151L5 /112f BYdt� ShBfE 0(IfIWfCtt?
-Ia-oi-�.oy -ouu. o�o-
NortgaBe ���a �ehtedness unpaid as of Mortgage / Cont
tl name m 2m�tl n Nrterent lhan Nat o( app6rant, cid'xate Debw.
Name of morigagee a contract seller
A4tl2ss ot rtart�agee or contrad sener (nurt�er anrl stree; ciry, state,
Name W assuyiee or Whu ovmer or Imider of mortgage
Adtlress of assigMe (number aM streeG rity, slate.
_s x� � f
Dces a�xant own pmperty in any other
counry m Intliana? ❑ Yes
❑ No
Dedumon approvad'm Ne amount oF.
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sigtawre d counry Auanor
e. �
I/ We certify under ihe
owner I contract buyer
1, Sigfqwre o�wne/sfuU '
` 1_ Fu0 rrsident .� W appG
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u res. wnat� nh?
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4Mat Tadng �ishict?
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Yes U No
IS tl�e W'oPertY in QueStian: MnuaAy A55e55eA
❑ Real ProPenY 0 ��Y �
Dra�ti�er i1'0.... °`�I `�--
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Ca rd 1��0. ... �% �
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� I oa�e c,�,....... , -
�Ne above arW foregoing in(ortnation is W e and cortect arM that the applipnt is a resident of Indiana aM
property on date application is filed. �
antl
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of AttOrtiey
Pddress of autha've0 pr�son (numbe! and streeL m}: sb1e. aM LP oode)
Data(rtmfh, aY.Y�a�
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