HomeMy WebLinkAboutMortgage_Elpers (23)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year �
• FOR DEDUCTION FROM ASSESSED VALUATION
� �• State Fo�m 43709 (R71 / 649)
�'' � presrn3¢d by Department M Lazl Gavemrtrent Frurce
File Mark
WSTRUCTIONS:
To be fifed in erson w b mad with the Co AWitor orCoun Recader o/ fhe ooun where the F� �� ���
a v �Y h h P�PertY is bcated.
Fdirg Dates: 1) Real Property: Must fJe during the year /or which the deduction is wughG � County Audimr
2J Mo6iie / Manufectured Homes not assessed as Real Property: Must fi!e dunng the hveNe (12) months
betore March 31 of each year the deduction is sought. ❑ Counry Recorder
See reverse side /or addr�nal inshuctions arM qualifications.
Ao�mlawmrarmntra uver.seercsbicbonsonBVersesidel /] A
Tamg District U I� rumher
AssesedralueaFrealp�opertyazof �
Ma�C11, acreN 1Rar 1
If 110. Whd1 IS hISI h¢f BXdi Sh212 Oi If1tPlP5i�
H name on recad 6 dMtemnt tlun that of aPP�ant,
r� m �s�re a m„ra� �oe�
Address of mortgagee a contrac� seller (numbe� ai
Name M asv�nee w otlreJ owner w haber ot morq
oounry In IMk
���
20 _
��� %�u��IL�J�
Ndkate 6ebw.
�J
city, state, a
� ���Dl�.v�i
Di•awer NO....�.OI�......
5��1��
c���d �io . .....................
m camb Nwitcr
VJhatTa�o�9 �¢trvi�
20
: aPP6rant tha soie
or equitaNe ownM
❑ Yes ❑ No
sGO�. hdkate wtth whom
Is Ihe Pro7eRY in Question: MnuaM AssKUd
❑ R� a�oae�+r ❑ a„r,�nya�a
Has Nis tleAUGion Oe
for wrteM Y�R
2� _
��,�
Yes ❑ No
Date (mwrth. daY. Ypa�
20
I I We certify under the penalry of perjury Nat [he above and toregoing intortnation is we and corteG arM that the applicant is a resident of Indiana aM
owner I contract bu r of Ne afaementioned property on date applicatlon is filed.
nad�e fowne/s $➢ 1 Date (month. daY. Yea�
r'rr.�
exewtetl Powet o(AttCmeY w Cy IC 61.1-12-0.7
af auNOraed prJwn (number an0 sneeS �Y. sbte, and