HomeMy WebLinkAboutMortgage_Denning (4)� � � �, P
"'� STATEMENT OF MORTGAGE OR CONTRACT INBEBTEDNE �(;oun Township Year
.__ ; FOR DEDUCTION FROM ASSESSED VALUATION ��/ �
State Fortn 43709IR71 / 6-09)
'v„ % �'�°e,,�,�""'e��„�'�°"e""��F"�` OCT 29 2012
File Mark
INSTRUCTIONS:
C '�.M'�.�.—� Fwmfiledwiih:
To be �led in person or by mail with !he CounryAuditor or Counry Recrorder of the county where the prope�y �s located.
Filrrg Dates: 7) Real Pmperry: Must file dunng Ne year for which the deduction is sought. V `� Counry Audiwr
2) Mobde / Manulecfured Hortres rrot assessed as Real PropeRy: M��eduri(rg Ne IweNe (L2}rr�p�ths
befwe March 31 of each year the deduclion is sovgA[. J � County Recorder
See reverse side for addifionel instiucWns and qual�cations.
AppGCan�(owne� wconvav byxer - see r�n�uru m revetse sidej
> �y �oe.
n�y�a �
!
e�a share af inteJesfl
-«w c.crJ du
� ca,racc ineenreaness unpala as w Mor�aye �
If nartre m remN a dAfe�en[ Nan Nat at aPp6qn; 6�d'uate bebw:
Name of mortgagee w mntract seller
Add'ess N nnrtga9ce w mntract se�er (numb� arM sfree4 u1Y, sta�. aM ZIP code)
Name ot assignee or other ovmer or Imlder of mortgage
AddreSS oi a55ignee (number aM stree4 �: 51dte, entl Z/PGOde)
Ooes appfitanl o-xn property in afry other I If yes. wha[ muntyl
munry in Indvna?
❑ Yes ❑ No
ction approvea um me artaum ot
20 20 20
20
unp2id as o( Is Ihe sPPGfant the sole
1e9a1 a eWipWe mmM
❑ Yes ❑ No
with someorre other than spouse, iMirate wiN wlwm
Is C�e property in Question: MnuaOy Assused
' � Real ProPertY ❑ MnuaDy0.ssessed
��T�� DENti1Z��G� l..�� p
j��.��9s �o
_ I cv 20 _—
Date (monN. EaY. Y��
I I We certify under ihe penalry of perjury that the above and (oregoing infwmation is true and cortect arM that the applinnt is a resident of IrWiana afW
owner I contract buyer of the atoremerrtioned property on date appiiration is filed.
a ers Tull narr,�e) �� Date (mmth. daY. Yae�
s W app� �ant (num ( cry, state, antl LPCatle)
�3 �' o W Oc.>c.,�s��%JC � ..r,.. �76
by EWy execvted Power of Attorney ar by IC G7.1-12-0.7
Address of authw'ved pem,on (numberaM sLee4 Nry, state, an0 LP code)
�ate (rtionM. EaY. YEa�
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