HomeMy WebLinkAboutMortgage_GentryI'
'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ • FOR DEDUCTION FROM ASSESSED VALUATION
. �• State Fwm 43709 (R71 / 6-09)
S ✓ PresaiEed M �ePartment M Lnml Govemment Finaxe
�TRUC� � � ile
TIONS:
To 6e filed in person or by mad with the CowryAuditor or Counry RecoNer o/ the county where fhe property is ��
Fifiny Dates: 7) Real Property Must fJe durirg the year for which the deductlon is soughG � Counry Auditw
2, be fore Ma2h 31 of eath year Ne dedeuttion s soughProperty: Must file dunng the Mrefve (12J monNs pE 1�512 (3� ty
n Recorder
See rcverse side lor additional insfructions and qualificatlons.
Appfrppt (qwrrerw wqfract buypr- see restpL`�.'uns verse sidey _
Assessed ralue a( real poperty az ot
Marti� 1. aamnt Year
II ro. whal Is his / her araa share of intrlesC7
If ranie on iecoN is dAtemnt Nan that of aDpl
Name of rtnrtgagee or contrar� seAer
/
�
Address o1 rtwrtgagee w cnntract seller (num
Name oi assignee or oUrer ownu or hddu ol
AECress of assigrree (num6�aMStreel �y.
Dces eppli�-ant own propen7r in eny aNrl
munry in Indvria? ❑ Yes �
( •1 'V�
A/or[qage /w� trar1� tedr�s unpaid as of
Mard� 1
If mmi
ant, Mtlica[e Celow
i�
u eM stree; ciry, staM, aM LP code)
mortgage
�'• +�l
- - - — � - � - - � COUNTY
Drawer NO....�..�. �•4�•......
� CaCd NO. .....l.�c!.'�.�.�.....
w � SiL�� � U.CT�
�Da�
ae / Can�'vWEC�
YMat Tadng D'avic[7
za _ � zo
��
Is property in Qi
Real ProPe�Y
�'u �lA..fa
Yes U Na
Has Niv deductian been requesteE an D�operty
�a^e^��' n ..__ n ,
xa_ � 20_
�going infortnation is true and corteci arM that Me applicant is a resident of IMiana and
ipplication is filed.
�gnawre �owners w u�nre�
l�ll "a..�
Fu0 msidani aOCres d appGcant (numberenC sLee4 �; ��e, ard LP cotlej
18 S. Nah Sd� �•:^cc@o� � �/]6�0
Prnon authuaed Cy d�Ey exearted Pv.�er ol AttnneY or by IC F7.1-72-0.7
Date (month. daY• Ysa/)
Date (rnorvh. daY• Y�1' _.
person(numberandsbeeS�+N.stala.arMLPtade) . _ ' _ _
< ,t. �:
✓