HomeMy WebLinkAboutMortgage_Cloin (2)^' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun vear
_,. _ FOR DEDUCTION FROM ASSESSED VALUATION
� n State Fartn 43709 (R71 / fi09)
4` � presoibed by DepartrneM al Local Govemment Fua�xx
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isrRUCnoNS:
«m mm �rtn:
b 6e filed in person or by mad wifh the CountyAUdiror or Counry Recoider o/ Ne county where fhe property is bcated.
Fr6ig Dates: 7) Real Property: Must file dunng the year (or which the deducUon is sought. Courrtypuditor
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2J Mo6ile / Manufadured Homes irot assessed as Real Property Must file during the M1veNe (12J months �� `\ �\
before March 31 of each year the dedudion is sought. ❑ C�nnty.�,ecorder
See reverse side lor additional instiuctions arM qual�cations.
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ed vaqm af «rd P�P�Y %s d
rd
7, ar�er¢ ymr
tt ro. what Is his / her e�act
If rurtie on recoN
p CMtrarl se9er
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Mortpape / Contraa indebtedr�s unpaid az ot
Mar� 7. WfRntyear
contract seDer fmrn6er erd street fA: sbte. aM LP oode)_
Name of assignea m other owner
own
prdumon appfwed'rt� Cie amoum oF.
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aage I Contr2�Y iMeMedne55 unpaiO a5 0( Is Ihe ePP�t the Sole
of appGration kgal w equitaNe ownell
Yes ❑ No
wmeo� ottw inan sPO�e.'uMiwte wM whom
�s tM propeny in Questim: MnuaOy Assesse0
Real Property ❑ Armually Assrssed . . _.
;�y oa��n r� �n� aea�a+«�Deeq��/�s�a � v�m
for curtent yra(.+ 1/r-J Yes ❑ No
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20 I 20
20 � 20 _
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We certify under Ne penalty of perjury that ihe above and foregoing infortnalion is We and cortec2 and that fhe applirant is a resident of IrWiana arM
l contracl buyer of the afQremerrtioned property on date application is filed.
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authamea oy
person (number aM strae; cGy, slafe, arM LP cnde)
Date (mon/h, tlaY.