HomeMy WebLinkAboutMortgage_Fetcher (3)^' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
.__ � FOR DEDUCTION FROM ASSESSED VALUATION
� State Form 43709 (R71 / 6-09)
�,,,, � PresoibeE by Department of LoW Gavemmenl Fl�aira
File Mark
INSTRUCTIONS: � �
To 6e fi7ed in person or by mail with Ne CounryAUditof or Counry Recorder of the counry where the propeRy is ��
Ftirg Dates: 1) Real Property: Must fi!e during the year for which Ihe deduction is sotghf. uditw
2) Mobde / Manufactured Homes rpt assessed as Real Property Must file during the hveHe (12) rzwnths
6efore Maich 31 of each year the deduction is snught ❑ County Recorder
See revarse side !or additmnal insUuctions and qualificafions. � C
nppGCant(owneror 6 r�seeresfrirlio s.r9�rseside) _� I C.�J.�•-��—\
Asscssed vaNe of real popertY es of
Ma2h 7, aQrera year
n �o. wna� Is na � ner e�aa snare or ��eresc?
It name on (emd is drtte�ent Ihan Nat
mntratl seller
of �ee ar mntred seDer (number and stree;
Name of azsignee or other owner or hdder of mortgage
bebw
If ownaE wi� mmeoere
nddress ot assw7nee (rwmcrl ene umet �: sb1e, ene z�v code) ..
Dces epplinnt a.m propaty in any o�her —.� f���f //���'(qj,,,, /'��� �
munry in IM'ana? ❑ rEi 1(,J'�' l�/, �� �
❑ Yes
DeCucUm aPWoved c� Ihe amount oE /� ��" �O
20 _ � 20
signaWre m cav:ty auattor
�e
Caunry
unpxid as d I§ Ne applirant Ne sde
leyxl a equilaWe oxnd7
❑ Yes ❑ No
sPOUSe.
is Gre MaGenY � Guestion: MnuaAy AssessM
❑ Reai a�overtr ❑ nrmua�y wssessea
for
20 _ � 20
oace (�m, dar. r��l
P��nY
❑ No
20 _
I/ We certify uMer Ihe penalry of perjury that the above aM foregoing intortnalion is true and cortect arW that Me applican[ is a resident o� Indiana arW
owner / mntract buyer of the aforementioned pmperty on date application is filed.
�� (C�Lo .�rmme)_ , �--Q� Date (monUi, day, yae�
,LJ d�
9 " ent add�s U a t(number arM sGee4 �Y, �ate, end ZIP�oE21 . ^ �_� � w
m
Pddress of authaae0 person (number arM sbee; tlry; state, aM LP cotle) . ����