HomeMy WebLinkAboutMortgage_Edwards (2)^'3 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Tovmship Year
� FOR DEDUCTION FROM ASSESSED VALUATION
n State Fartn 43709 (R71 / 6-09)
S presaiDed by Departrtrent af tnd GovemmeM Firerce
File Mark
INSTRUCT70NS:
To 6e fi/ed in person or 6y mail wifh the CowtyA�ditor or Counry Recorder o/ the county where the pioperty is focated.
Fdirg Dates: 1J Real Properiy Must fJe dun� the year (or which the deduclion is sought.
2) Mo6Be / Manu7actured Homes not assessed as Real Property: Must fiie dwing Me fvrelve (72) months
6ehie March 31 0l each year fhe deduction is mugh[.
See reverse side for additional insVUCGons and qualifications.
MpG�n�(owrrer ormNad buyer' � reSbxLyLtt m reverse side)
-� t__, �.
I!T7RT^P,L-.'L
rc m, wfiat Is h'a / hel eraa share ot interest?
tl narne m maord is 67ermt Ilwi that al appGwn, trtlkate 6elov.
f�
mno-aa sene,
Name ot assi�ee w othr! avmer or holder of mortga
Address of ass9�ree (nurtibuaritl svee; city; state, a
Oces eDPlinnt ban
counry in IrW'ana?
�. (�-gf»unry Auditor
-E�b fo�3�00 ���5 yp !c
nrss unpaid as of Mortc�aga / ConVxt 4Webttdness unpaid as of Is Ne appRpnt the sde
date of aPPOptron legal w eWitable amell
❑ Yes ❑ No
tt wmad wi� someone othes than sPCUSe. hWicate wtth whom
�.V�.....
Dra�ver \O.. .
at��....
�Card9\O. .. ��•/�'�
�;s���o,p.
Is tl�e P�PenY m Guestion: MnuaOy Asses:ed
] Re� �o�ro ❑ wII,�iN w�
��a r�,� nc c
Has iha dedutlion Ceen reque5te0 af prapelty
tor wrrent yeaR ❑ Yes ❑
COUNTYAUOROR
Deduc6on approved In the amwnt of.
20_ 20_ 20_ 20_ 20_ 20_ 20_
s'ryranne d Caimb nwitm counry o-ate (mo+uh. aar. Yead
I/ We ceNfy under the penalry of perjury that the above arW foregoing infortnation is We and correct and that the applipnt is a resident of IrWiana aM
r/ mntraU buyer ot Ne afofementioned property on date appfication is filed.
vme/s f� ireme Date (mw+th, daY. Y�)
W ' nt addres of a t(numher f ory, state aM LP ) u1 ' ^/
_1 C � O
PeJSOn authoractl Oy dWy eiecut¢d Power otAttomey ar by IC G7.1-72-0.7 Date lrtpnN. Oay, ysa� - _
Pddress oi auCwrtred Ge� (number arM svee4 mY• srate. arM LP oode) .