HomeMy WebLinkAboutMortgage_Davis (3)_rySTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year �
FOR DEDUCTION FROM ASSESSED VALUATION
�• State Fortn 43709 (R71 / 6-09)
S,,,, I presaiheA �y DePa«<��M of L.ocal Govemrtrent France
I
INSTRUCTIONS: ��i
To 6e (led in person or by mail with the CountyAuditor or Counry Recorder o/ the county where the property is lo � t��l. 2 5� I I I/���
FiNng Dates: 1) Real Property: Must file dunng the }rear for which the deduction is soughf. �� Counry Auditw
2J Mobile / ManufaUUled Homes not asseued as Real Properry: Must file dunng the hvelve (12) rrroMh , .
6efore March 31 ot each year the deduction rs sought. ( � Counry Recorder
r
See 2verse side lw additional insVUCGons arM qualificafions. � n� ,, T
Appfitanl,(owneroroonCadbuyu-s�eyesfictionsonreversesifa) /� . . . . . •
T' Distri� J Key fuun / legal E Ption
�o - 9- - 0.3 -
Asessed ra4ie af 2al poputY as ot Mo�qage / Contraa indebtedness unpa
Ma� 1. qrmnl year Mart�h 1, a�rtent yeer
If no, what Is his I her ezact stare o( interest?
If name m remE is Ailferent Nan Nat of app(rant, uMiCate Debw:
Name ot rrongagee m m�tract se0er �: A'
.Q.�'�/ %l/��'.�}2-�i
U �"u-� / - -
AEdress W mort9agee or cantrad se0er (numbrl end stree; ctly, state, aM LPcode)
Name of assignee w other owner or
PdER55 Ot
property in any oNer
❑ Yes ❑ No
OeGUCOan app�oved In Ne artaum of:
20 _ � zo � zo _
SignaMe d Caunb A�Wimr
C •T- �v�n�yflm.e,
I/ We certify under �he penalry peryury Ihat
_owaer I contraU buyer ot ihe atoreme�oned
awy
i%S-o�
MflaQe / COnt2G[ iM
If awned vrith
R
Rem�d numbr! P n���
> unpzid as o( Is Ihe aPP�t the sok
le�pl w eQUitahle axnrYl
❑ Yes ❑ No
indi�ate with wlwm
� P�Pert1' in 9uestion: Mnually AsesstM
Real ProPertY ❑ ��Y �
Dra���er NO....���......
couNTV � � 52 �
Card \'O . ...... ............
zo � ��,�yo, b6
Caunry
Date (rtronth, daY.
� v�r
. ❑ No
hi�;
M foregoing infortnalion is true and correa arM ihat the appiicant is a resident of IrWiana amf
date appliratlon is filed.
oate (monfh. dav, Yae�
state, �LPootle)
person (num6erantl sbee( tlry, state, andLPoode)
(monN.daY.YeaA
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