HomeMy WebLinkAboutMortgage_Toooley^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun shi r
_. � FOR DEDUCTION FROM ASSESSED VALUATION
� � Sfate Form 43709 (R71 / 6-09)
�' Presaibe0 q' Oepartment of LoW Govemment Fi`ance
wsrnucnoNS: �L��i� Z��2
Fortn fileC wiTh:
To be filed in person w by mail wdh the CountyAUddw or Counry Recorder of the county where fhe property is bcated. C 1�,
Fdirg Dates: 1 J Real Pmperty: Must file dunng the year lor which the deduction is saughG � ���ry i�
2) Mobile / Manufactured Homes rrot assessed as Real Property: Must file dunng the twelve (72J months n c� �
6efore March 31 of eacli year the deduclion is sought G�g p N`�JU rv � x��
See reverse side tor adtlitionel instrucUons and qualfications.
Anofitam (owlr�eStmYdU bN'a/'sea rciV�Pim verse S01a1
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irnal p'apttty as of
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Oilflf¢f¢Sf?
' hbr(qage! Canbaa 4
Martl� 1. wrtent ypar
If name m 2md is ddferent Nan Nat of aPP��t ��re Gelow:
Name of rtwrtBaBee or
- �a� �d�0 -0� �
�� unpaid az U Mortgage I Contract indebte0nrss unpaid as 15
date of eppGcatm / les
If owne0 wiM wmeorie other than . iMirate with whom
w mntratl u�er (numb�erM stree4 �}; sb+e. eM ZIP mde)
w otlrer owner w hddar ot mongage
(number and svee4 �Y, sfate, and LP co0e)
Does eppti�nt am property in any oNer
counry in IMiara? f
❑ Yes i
Dr�uctlw appioved'ui Ne amouni of.
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SignaWre
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Is e propesty in Qi
Real Property
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� ��,�,� nYraR � Yes ❑ I
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under Ne penalry o( perjury Nat the above and foregoing in(ormation is We and correc[ arM ihat the apptipnt is a resident of IrWiana and
act buyer of the afaemerrtioned properry on date application is filed.
slu0name)_ " Date(monfi.EaY.Y�A
sLee4 mY. ��e, antl LP cotle)
person (number eM sbeet ury, sbte, and LP mde)
Date fmonfi. tlaY Y��
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