HomeMy WebLinkAboutMortgage_Miller (8)^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
: FOR DEDUCTION FROM ASSESSED VALUATION
n State Fortn 43709 (R11 / 609)
� Presaibed by DepartmeM af Local Goremmenl Finance
�� File Mark
lSTRUCTIONS:
To 6e Ided in per5on w by mail with Ihe COUntyAuditor or County Recorder o( the co�nty whe2 Ihe prope�ly is located. O C F 1de
Fling Dates: 1) Real PmpeRy: Must file dum1g the year for which the deduclion is sough[. C Counry Auditor
2) MobAe / ManuFactured Homes not assessed as Real Property: Must file dunng the hveNe (72J months
befole March 31 of eech year the deduction is sought p' Rec°�de�
Seereverseside/oraddrtiona/instruclionsandqual�cations. GIBSON U ITOR
A�ssed value d rPal pqpp�ty�spf
Mart�h 1. amyu year � �7/�
11 ro, wha[ a ha / her ¢�G share O( interest7
tl name m�ecaA is dilfemnt than that of ap
Name af mort9a9ee a mntraC seQer
l�.
ALtlress ot rtwrt�agee a cantract se0er (n
Name of asvgriee or oflw ornet n holder of
AaE`ess of assignee (numOe+ard stree4 r.�:
p,..� e.w;,7,� �n ormrlN in any oNer_
� _ .
p(rant, uditate Debw:
�� sbee4 �Y. stam. aM:
mortgage .
�
sfate, andLPOOde)
If yes. what muntyl
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llra�F•er NO..IX�...:�:...
n�
Card NO. .....°.?`�'.:��.
- I 11� �SSc�. c..� . ..
!*
� �mvaid as d Is Ihe ePP��t the sole
legal w epui�aWe o.merl
❑ Yw ❑ No
ildicete with vrtnm
�Is propenyinVUesGar.MnuaOyAtisesuV
Real PropeAY Q ArmuaOy A�ssed
� ��11� �� � �
What Taring Datrict7 Has N's deduGion be
for wrRnt yeaR
)UNTYAUDROR
zo _ zo _ zo _
;ted m D�Y
Yes ❑ No
oa�,�,,, �Y �e�
,s��
I/ We cerdfy under �he penalry oi peryury Ihat the above and foregoing infortnalion is We and cortect and that the applipnt is a resident of Indiana a�
owner I contract buyer of the afaementioned property on date application is filed.
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' af Attomey w by IC 61.7-72-07
! stree; tlry, stale. aM LP Code)