HomeMy WebLinkAboutMortgage_Matsel^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ship
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
( . . � Stata Fortn 43709 (R71 / 6-09J
ti,w � Pfesaibetl Cy �eP2RmeM of local Ccvemment France
���a�2 2��2
�srRUCnoNS:
6e filed in person or by mail wifh the Counry Audito( w Coun Recorder ol Ne cnun where the ro �� ��
Fdi Dates: 7) Real Pmperty Must fde duri the ry ry P PertY is located. �. �.Ir �--
rg ng year /or which the deduUion is soughL Cou r
2J Mobile / Manulactuied Homes not assessed as Real Properiy Must file dunrn� the tweNe (12) months �I''I �
before March 37 o/each year the deduction is soughf. GI S01!-QOl�lB� ef{j
See 2ve,rse side for additional instn�clbons arM qualdicafions.
Ai�ssetl rahie of real P�O�Y a W
MaU 1, qarentyrar
tt ro, xRat a his / her e�1 share ot interest?
-( _ - � Ooi- a0 ,
ort8age / Contraa intlebte0ness unpaid as W Mortgage / Cp
March 1, arrent year date af appGra
II nartre m rem�d is GiRerent ihan Nai ol apptirant, mGinte bebw:
or mntract seller
,�r—'.�`-.r'BJ
Name ot assignre w other owner or holder ot mortgage
Stdta,
ACCress o( aaignee (number aM stree4 �1: �te, aM ZIP mCe) - —
Dces applicam ovm propeM1y in any olner If yes. what munty?
munry in Ind"ana? �__ �__
Deauction apywed in Ihe amount of:
20 � 20 � 20
Whal Ta�d�g DisVid7
COUNTYAUDROR
20 20 _
Counry
num6er I Paae num6er
uWe6teAness unpaiO as o( Is Ne epp6rant ihe sole
legal w equitade ame/?
��� ❑ Yes ❑ No
sPOUte. indrate with whom
DroOeRY il10��: M1fU2MllS5C55Cd
�1 Properry ❑ Amwaly Assessed
AbhBe I-brtie OC fri.1
__ fJERsK A�
(�PTS�L.�/�,EtsssR �'
I I's� a,l
20
Date (monlh. daY• YEa�)
�
I/ We certify under the penalry of perjury that the above aM foregoing infortnation is We and corteU and thai Ne applican[ is a resitlent of Iridiana aM
owner I contrad buyer of ihe aforementloned pmperty on date applicaDOn is filed.
��.:.t�,...o ,_
FWI resdent add of appGrant (rwmGer ard sbeet, cily, stare, antl ZIP aotle)
� D rm�-l� A�n: ree f r 8
Person auftronzetl by GNy ezecutetl Pa+nx of Attomey or �y IC 61.1-12-0.7
person (numoer a� strec4 �ry. sbte,
.��N '� y7/o� 8