HomeMy WebLinkAboutMortgage_Southwood^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co owns ar
__ _+ POR DEDUCTION FROM ASSESSED VALUATION
�• Stafe Fortn 43709 (R71 / 6-09)
� P�esvibed M DePa�ant of Lod GwemmeM Fuance �c
�STRUCTIONS: D E (. �'
Fortn Ned with:
To be filed in person a by mail with the CounryAUditor or Counry Recorder o� the county where the property is located.
Fil'mg Dafes: 1) Real Pmperty: Musf 6!e durirg the year for which the deduclion is soughL -�• �'4�� ���AuEitnr
2) Mo6de /ManuFadured Homes not assessed as Real Property: Must Ae dunng the tweNe (12J months ❑
before March 37 o)each yearthe deducfion is sanghG ��
GIBSO
See reversa side /or addi(ional instrtrclions and qual'fiications.
MW��1SowrreswcoQtraubuyer-seer�strictjynsmiawrseside) .
s��
wrtentyeer
share of intrmY?
It riama on remd is Eifterent Nan Nat o1 appGcant, h�Okate Delovr.
ormQtgagee «mntraa
of ytp[yagce w contratl
w other owner or holeer of ttqrtgage
- _c��a-aa
ss unPaitl as of Mongage / Cantrars
tlate of appGptim
ctiy. sbte. aM ZIP cade)
AECress of as9gnee (number aM sneet �1: �te. antl Z/P ootle)
Oces appli�ant wm pmpeny in anY oNer U yes. wh
munry m InOiana?
❑ Yes o
Drauction appmved 4i tlie amount of:
�_ � �_
Signature of Counry Auditor
It owned wiN someo� other Man spouse.
GOUNTYAUL
R¢cocd numbel � Page number
���a��
� propPrty in Vuestion: MnuaM AssesseE
Real Roperly ❑ Armually AS�ed
n�oa� � nc u
' /-� 0\�.•
� 1 .•',.
, /�\��
`O ,.
,l, ��\ C� ~ , .
V �.�0 r�,'ij�?li�� —
C�� � \��'
20 � 20 _
Caunry
No
�_ 20_
Date (narGR Cel: YEe�
I/ We certify under Ihe penalry ot perjury that Ne above arW foregoing intormation is true and cortect arM Nat the applinnt is a resident of IMiana a� �.
owner I �*�^� ^�^�° of NCaforementioned property on date applintlon is filed.
(owne/s
aty, sGye, antl LP catle)
�ecuted Power W AttaneY a bY IC 67.1-t2-0.7
ME�s of authar¢ed persai (num0er aM snee4 �1: s+ate.
� (�
zf �G 70
Date (rtanN. tlaY. Yze�)