HomeMy WebLinkAboutMortgage_McEllhiney (5)^�� STATEMENT OP MORTGAGE OR CONTRACT IND�'f�D�ES�
• FOR DEDUCTION FROM ASSESSED VALUATIO
• Slate Form 43709IR11 / 6-09) O
S �, � �,������o,�����F� DEC 1
Year Q
File Mark
INSTRUC710N5: C � � �
To be fi(ed in person or 6y mad witA the CountyAWitor or Counry Recader of the county where the prope is ted. Farm Ned wiN:
Fi7irg Dates: 1) Real PropertY. Must h!e dunng fhe yearfor which the deductlon is so}(9p(.,�N c:pU� TY AUDITOR Counry Auditor
2) Mo6i/e / Manufacfured Homes not assessed as Real Property: Must R7b�drmg trte hveNe (l2) months
6efore March 31 of each year the deduction is sought. � County Reoorder
See reversa side (or addrtional inshucWns arM qualifications.
Pfaant (o artonLart buyer' see � an reverse sile) /'' C �
i
T' Distrirl Key wmber / legal desai tion
-� -�5-io 00�1.�59 -o -
AsesseE ra4re d mal �aopaty az d Mortgage / Contract 4dehtearress unpaitl a ot Mongage / Conr
M2idi 1, oment year
If ro. wfiat is h's ! her e�oC share ol inte�est?
It name m remrd's 6'Suent Nan Nal o( aPpl
Name of morigagee or mntraG sellu j/'''(
( J/n��
Pddress o1 mort9a9ee w mntracl SeDer (numbel erd sfree; r]ry. Ya�,
Name of assignee a other owner or hdder of mortqage
H owned v.iN someone oNer than
numbu
�. 5 �
unpald as d
I ❑ Yes ❑ No
spouse. Indkate wtth wham
Is ttie prapeny in ques�on: Mn�aM AsseseO
�Real RoPertY ❑ %vmuaRlASSessed
Mo6ile Home (IC 61.7-:
��
Ad�2ss ot assignce (number arW slree4 mY, s+e1e, erM ZIP code)
Dces applifant wm property in any oNer I( yes. what count�? 1 ��!.. ��.. �J.+� � ��� �" m P�Y
munry in Indiana? ❑ Yes 1� �
❑ No „nn�_ l l.i�l.L ❑ Nt
� � ������
COUNTYAI I�— I I`C�
D�ucCOn aDP�d'oi tlre amount of: ��J J
ZO_ 20_ 2O 2O_ N_ Za_
sy„�wre d co�mb a,dnor cwnry oa� pr,wn. dar, rEa�
1 I We certify under ihe penalty of perjury Nat Ne above arW foregoing intortnatlon is We and mrrect and Nat the applipnt is a resident of Indiana and
owner I wntrad buyer of the aforementioned pro rty on date application is iiled.
X��wne. � hA na{' �%/��/ //// Date (monfi, daY. Yged
Penm
person (numbe� and sIIee( rify; state, am! ZIP code)
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