HomeMy WebLinkAboutMortgage_Prater (2)�
"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun sh
_,_ FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709 (R71 / 6-09)
�' � Prewibed by Deparlrt�eN of Local Govemment Fnance
� File �
�STRUCTIONS:
Fortn fik3.
b 6e filed in person w by mail with the CounryAuditor or Counry Recorder o/ tl�e county whe�e the pmperty is located. ���
Fi6rg Dates: 1) Real Pmperty: Must file durirg the year (or which the deduction is sought. � County Autli r
2) Mo6ile / Manufactured Homes rrot assessed as Real Prt�perty Mus! file dunng the M1veNe (12J months IB� ��.���rTO
6efore March 31 o)each year the deducfion is sought.
See reverse side (or additiona/ insWCUons and qualficatbns.
n wrrerwmntraftbuyzr" ^, reverseside)
i
T' Distr'rY Ke her al desaiGtion Remfd rwm0u Pa9e .
, / -i � i�-�o � 000.�a�-a� a �a�a .�i �
�
Y rrdl property as o( I rd� 1 e/ Contracl'v
Y� Ma . airte�rt year
Ir Iq. wltat 5 tti5 / I�er exaa s�tare ot ir
H name m 2mfd is QAFemnt Nan Nat
Name a m�agce «cmaa�c senu
rtnrt9agce or mnnaU se0er (ntunbar and strae4 �Y, stafe. aM ZfP oode)
Mdress of assgrree
Dces applin�LL avm pmpesty in any oNc
counry m IMiana?
❑ Yes
If awned wiN someorre
��e `�� � /� - 3 —/
s�, ad LP mde)
I( yes. what muntyt What Taring D'stria?
No
_.___ COIINTYAUDROR
apia
DI'1��'CC \� ...................
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�`ti `7_�w,U r�,rm,�
dty, state, aM
�J
2� , 20
caunty
unpaiO as o! Is Ne aPP�i the sole
legal w epuitade o�mnlT
� ❑ Yes ❑ No
spouse.
Cre P�o7enY m QuesOOn: MnuaOy Assessed
] Real PfOPenY ❑ ��a�Y�
a�otae rro� nc �
/
Has Na tleduflion Eeen reGUesteE m P�nY
tor a�rent Y��' r-� r-� .
� I �
'oregning infortnatlon is we and cortect arid that the applinnt is a resident of Indiana arcl
aate appfi�adon is filed.
Addrrss of aWio�'ved person (numberarM sbael, cky, sta(e, aM LP cade)
Date (manfh, dzY. lea�