HomeMy WebLinkAboutMortgage_Ellis^'na STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
• FOR DEDUCTION FROM ASSESSED VALUATION
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• - State Fortn 49709 (R71 / 6-09)
,' ,,,. � Presmted by DeOa�nt af Laal GovemrtreM Fuarce
To be fi� in person w by mad with the CountyAudifor or Counry Recorder o/ Ne� �� e� r/s located.
Fd'ug Dafes: 1) Real Property: Must fJe during Ne yaar Por which the deduction is so t. �
2) Mobde /Manufactured Homes rrot assessed as Real Property: Must t���ir� the ��I�� (12) monfhs
before March 31 of each year the deduction is soughG �
See ieverse side for additional instnxGons arM qualifrcafions. _ C��� m°�y
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Mamh 7, aaRnt yPal
tt no, what ts his / her eraG shara ot interest?
If name m record is 6fluent than that o( aPP��L trd'uate hebvr.
w contrsa
M rtprtgagee or rantract seller
Name af assignee w other ownu or halder of mortgage
sta:e.
� ��A�S�N COUNTY
5�7 �33-c�a.3�;
idehtedness unpaid as o( Mortgage / G
Address of auignee (numbe�aM s0eet �}: sbte. end LP code)
Dces epplinnt wm property in eny oNa tl yes, what munly7
counry m IrWana? r� .. ' r-� __
e
zo
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���ls� �}rs� �
G3A O ,�
�,�o� I�-�I�3�
1/ We ce._., _.__. ..F ��d�ry or per7ury that(t�e a6ove and fc
owner I contract buyer of the aforementioned property on date
sfate, emd LP
e
d authuized persan (numberend sbee4 dry, state, eM LP cade)
IWh2tTaritg District7
JNTY AUDROR
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Year
File Mark
Fon„ mea wl
County Auditor
❑ County Recader
r:em�d
4�dehtedness unPaid as of Is Ne ePD�ant ihe sole
legal w equltable ownen
n Yes ❑ No
Is tlie property in Qi
❑ Real Property
n^. ir7
Has Nis tledurlion been re9ueste0 m P��Y
for wrrent Y�/! ❑ Yes ❑
zo
Date
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�mia[ion is true and correU arid that the applicant is a resident of Ind�ana arcl
is filed.
Date (month. daY Y�a�
�r. r��
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