HomeMy WebLinkAboutMortgage_Rogers"'*v STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ip `
__ % FOR DEDUCTION FROM ASSESSED VALUATION
� State Fam 43709 (R71/6-09) . �
�` ,«. ✓ presrn'bed by Department af Lacal Govemrtrent Friance
INSTRUCT70NS: F�� � 20�
To be fi/ed in erson or b mai7 wiN the Coun Auditor orCoun Reco�der o! the coun where the F� m� �:
P Y b H b P�PeAY is located.
Filirg Dates: 7) Real Property. Must file durirg the year Por which the deducUon is soughL �� Cou u r
2) Mo6ile / Manufedured Homes rrot assessed as Real Property. Must fi!e dunng the hrelve (12J months n
before March 37 o/each yearthe deducfion is sought. � G� SOk-Cp�jT�AUDI ef
See reverse side for addtional instructnons and qua!'dications.
MWmN� (owrerar mntraC buYer- aee restri�ons m reverse sedel
A}a� 7. aarent Yrar .
Ii ro, what is his l Mr exaU shara of interest?
If name on remd is E'itterent Nan Nat of app�canl, uidifate below.
cantracl sWer
or othei owner w hddar af mortgage
��
Address of acsi�ee (number aM atree; tlry, state, and ZIP code)
Dors epplimnl ovm properry in any oNU If yes, wha[ munt�?
counrymindvna? � .. � _.
zo � zo �� ��o
RecoN numbrl Page numbrl
a 2- (.Oii
wPaid as d Is ihe aOPGranl Me sde
legal or yquitaWe ownM
No
spouse,
is the WooP�Y m questiwc Annu
�Real PfOperty ❑ ArVlual
MoWle
� � y3,�9�3, �� — -�- -
WhatTa�dfg Distria?
Dra���er NO....��.�......
\UOROR
ca�-d ��o. ....�Ob........
_ Zo_ i zo— i Z�— �
I/ We certify uMer the penalry of perjury that the above and foregoing intortnation is We and cortect and that the applipnt is a msident of Indiana and
wmer I mntract buyer ot ihe aforementioned property on date appliratlon is filed.
? ovmerY fi��) � Date (montl+, daY. Y��
S. JD`% L'i✓ f1�vg S i.4iSi
by dWy eaea�:ed Power of Attomey w by IC 67.
Add25s of autho(v1tl person (num0er eiM sheef, dry, sfafe,
Date (monfi. dal: Y��