HomeMy WebLinkAboutMortgage_Reid (2)'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
,__ : FOR DEDUCTION FROM ASSESSED VALUATION
� State Form 43709 (R71 / 6-09)
�,�,� 1 Presrnbed q DepaRmeN of Local Govemment Firance
Q
Coun TAwnstv Year
File Mark
wsrnucnoNS:
b 6e filed in persan a by mail wifh the CouniyAuditof or Coun Recorder of the co�n where the io F0� ��'
ry b v aem � rocared.
Filirg Dafes: 1) Real Propery. Must h7e dunng fhe year /or which the deduclion is sought ����Q �P�verp��Auditor
2) Mo6ile /ManWactured Homes not assessed es Real Property: Must file dunng the fweNe (12J months l\ \
before March 31 of each year the Ceduction rs sought. ❑ CLun � er
Seereverseside7ofarlditronalinstnlctionserrdqualilcations. GIBS niinirv �t��
AppGtant (o or oonbarl6 - see msLirL"wu verse sba)
T' KeY numCel / legal Eesaiption Remrt1 rqm�EC Page numbni
a�- 4- -ao�-ao�. � - ab t�. ���a
A�d rdue oF real paperty a af A1ortpage / Contract tr�EebteOr�s unV� as a( Morigaqa I Con�'uqebte0ness unPaid as d Is ttre ap�ant the sde
Msmh 1. aa'enl Y� March 1, arre�` y_ear Eata o( aG� legal w eWita6le ameR
� tl�'Q(�(� �Yes ❑ No
u�o.w+a���ine���a��?
If name an �eco�tl's 6RerPnt Wn Nat ot appOtant, mdicate Eelo�r.
Name of ag or mntract seller
o`�-��" h��
A�tlress of morcgag w mntraa se0er (numbe� and sbeeL laY. sla�.
Name of assi�ee w athu mmer ar Imider of mortgage
A9dress o1 assi9nce (number aM sveef, ctiy, stete, aM Z/P code)
Oces aPW�nt own property in any olher I! yes. what m
ane.+�� sro��. mc�+e wm �
/�E�D �ihcs✓�
SN�RA �
/�? -yy��
NTat Ta�dng DisGicl? Has Nis deduGim Ocen�Q ues�ted m propercy
forcurtemyraYl hf7� � No
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COUNTYAUOROR
Deducfian appmvcd'v� tl�e annunt of:
20 _ 20 _ 29 _ 20 20 _ 20 _ 20
SigreWre d Cound Aud'aur Counry Dam (rtqnrh. daY. Y��
I/ We certify under the penatty of perjury that Ihe above aM foregoing infortnation is W e and cortect arW Nat Ne applirant is a resident of Indiana aM
ovmer I contracl buyer ot the atoremerttloned property on date application is filed.
Si9 (awners hN rmme) � Date (rronth, daY. YearJ
F A`esiGent address W appfmant (number M sbcet a, s+ate, aM IPaotle)
E 6 8
aulMraN by OWy ezeateC Porer of Atmrtiey ar by IC 61.7-12-0.7 Date (monN. Oay, yea�
Mdress of authaaed 7� (numDeraM stree4 �: sbte, aM LP code) .
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