HomeMy WebLinkAboutMortgage_Seibert (3)'�� STATEMENT OF MORTGAGE OR CONTRACT IND �
: FOR DEDUCTION FROM ASSESSED L��� Coun Township Year
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• Stata Form 43709 (R77 16-09)
•�' ,,,, � P`esrn'bed M�P�erit o} LoW GovMmmnt Fratxe
File Mark
INSTRUCTIONS: n[(�� 1 � 't0�2
To 6e filed in person o� by mail with the CountyAUditor orCounry Reaorde� oAESe lb nly where the property is bcated. F� fl� ��
Filirg Dafes: 1) Real Pmperty Must fife during the year for which the deduction is s � County Audimr
2) Mobite /ManuFadured Homes lrot assessed as Real Prupert}Q�/�ia e d hvelve (12) months
betore March 31 of each year the deduUion is soughG ❑ County Recorder
SeereversesideforadUi6onalinstnrcUOnsarMquelifications. _��NCpUNTYAV��T�R
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I vWUe of rpal prpppny ffi ol
ame'V ypar
of inteJest?
Name of mortga9ee or
naa� m �,wny�ee «�,vaa
nu+nbu
���0/I/IC
�w� naG� tetlrress unpaitl as a( I�ongage / G�� 'uNebtedness unP� as d Is N�
PP �
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if ovme0 wi� someune oNu than spouse. Indxafe wlih whom
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ovmer or htlder of mprtgage
�er aM sn«4 �3: state, eM LP catle)
Dces applirant wm property in eny olher If }
munry in InC"¢na?
❑Y ❑NO _
De�umon apprmed'c� the amount of.
20 _ 20 _ 20
s�y�m�e d c«ma a,ar.�
what munryR � NTat Tas
�itable owner/
Yes ❑ No
Is Me P�PenY m Question: MnuaDy Auesud
�teal PmPertY ❑ AmuallY Auessed
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Dra tive'r i\'O..(���.
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Card 1V0. . ..�,��,.{ �
�b�'�`ro.....
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20_ I 20_ � 20 I 2U_
Date (rnGnfh. daY. Yea�)
I I We certify under the penalry W perjury that Ne above and foregoing informalion is true and correct and Nat Ne appliqnt is a 25ident of Indiana a�M
owner / contract buyer of the afwementioned property on date application is filed.
�nayrelowne/sl�reme) Date daY.Y��
��fl�ri.�l� � �e,�� ���7 I �
A r��nt adtlress t(wmber artd streef, Wy, sAte, arad LP ootle)
by IC 61.142-07
lbaress of aWror'¢ed pe�mn (numberarM sbee4
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