HomeMy WebLinkAboutMortgage_Cummins (2)rynv STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
.._—..
� FOR DEDUCTION FROM ASSESSED VALUATION
• Sta[e Form 43709 (R71 / 609)
�` - i p��betl q' DeP�meN of Loml Govemment Finarcx
r.
Coun Township Year
1� fiC
�NSrRUCnoNS: �
To be filed in person a by mad with the CountyAuditor or Cowry Recorder of the counry where the property is Iocated.
Filitg Dates: 1) Real Property: Must ble dumg the year /or which the deduc6on is sought.
2J Mo6ile /Manu(actured Homes rrot assessed as Real Property: M�st file dunng the fwefve (12) months
before Mamh 31 oJeach year Me deduction is sayht.
See reverse side /ol additional instrucUons and quelifications.
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T ' striti Key�vanbefl 9aldesaiPtian
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Ma�d� 7. amerrt year Marrh 1. wrtenl
u �o. �mat � na i ne� e� � ur �,�sn
Ii rwne m remrtl is dMe+en[ ttan Nat af app6ranl, mdkate bebw.
Name ar mortgagee or
Dces t
munry
«mno-ad
a/ assignee w other awnu or holder of rtprtgage
N4V � 4�bhfntyAuditor
I- oun Remrdu
C�1M�e._. ri
Rem�d numDer Page numbel
- oo _000• 3 99-o a 7 o�mn5 � y 39
baU 4dehtedness unpaid a of Mwtgage / ConVact InOe6te0ness unpaid as o( Is the appGrant Ne mle
year dafi of appOntion legal or equitade avmerl
/�f0 nnn ❑Yes ❑No
someane other
and sheat a1y, stafi, and LP coda)
3l-I—la 3.4s�AC.,
i any othc If yes. whal countyt What Tadfg D'atricl?
Li
whmn
,�tY m Cuestion: Amua�y Assescd
Ptoperty ❑NmuallyASSessed
�
D►•a�vci• \To.�e� 5
Card NO� F.IJy�I. �......
������ ❑ Yes ❑ No
COUNTYAUDROR
DaiucUOn approved i� the artrount of:
20 _ 20 _ 20 20 _ 20 _ 20 _ 20 _
$igrahrte of Co�m uCitor Counq' Oate (rsmM. daY• Yea�
���
I I We certfy under the penatty of perju that the above and regoing infortnation is We and correc[ arW that the�applirant is a resident of Indiana aM
owner I wntrad buyer of ihe aforemerrtioned property on e appliratlon is filed.
XSig�avre (owne/s fi!1 �me) Oate (rtnnfi. daY. YaeA
�ID resiAenc etltlr� W appGmnt (number and sheet, tlry, state, arM LP oo�e)
Per�..on autho�¢ed by dWy exewted Power o(At[omey or Cy IC E7.1-72-0.7 " Date (rtronfh. day, yEal/
lbtlmss of autlia'¢ed person (number e+M sbeet �+N. s1a(e. aM LP cnde) .