HomeMy WebLinkAboutMortgage_Asay"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_. • FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R71 / 6W)
�' ,w. ° PresrnbeE M DePartmeM of Lad Gwemmerd Fuance
e a
�TRUCTIONS:
To 6e filed in person w by mail with the CowityAuditor or Counry Recorder o/ the county where fhe piope t. m
Fding Dates: 1) Real Property Must file durirg the year for which fha deduction is soughL Counry Auditor
2) Mo6de / Manufadumd Homes rrot assessed as Real Praperty. Must Ae during the hvelve (72) monfNs� r� r� �� Ty
before March 31 of each year the deduclion is sought � U C l, i Coun Remder
See feverse side /or additionel instructbns and qua/fipGons.
MMk?�� (owner orcontrau buyer - see restrirZbns m reverse side) / _ �
legal desaiption
-�3 _oa -
,.�r-. u
tt �arne m rem�d a 6ffemnt t)wi Nat oi aOP��L hdirate bebrr.
rUme ar mortgayee «conrra� s� �er /1 �
l.J l ._
AAdress ot nwrt9a9ee w mntrad seller (num6er erid sbee; cify, slate, aM i
a other owner or hdder ot mongage
Ad�255 of assignee (numDer ared 54eef, dry, sfate, aM LP code)
r E a--� d y.00
Dces aPd� � P�PenY in a�ry oNer tl yes. what muntyl
cauncy in Ind"ana? ❑ Ye5
❑ No
20 I 20
� - / • /V�.fJY'
I/ We ceAify under ihe penalry
owner I contracl buyer of Ihe a1
by duty execuced
20 _
that the �
ned property
eef, M}; state,
A
ywbylCl
20
��-DO/. 7�3-D
unpald as N Mwigage / Con:2G i
�
NTai Tadrg Datrict7
20
I'�iJmbel"" �
.�
as W Ls ihe aVPfimnt Na sole
legal a equitabie va+idl
❑ Yes ❑ No
xitt�whorn
Is C�e ProOPnY in quesGOn: Mrwalty Assessed
�'iteal RoPerly ❑ Mnual�Y Asse�ed
r�w� � nc ��.
Has Na tledufYim Eeen requested m ptopPJly
(m current W�' ❑ Yes ❑
20 _ � 20 _
e and foregoing infortnation is true and cortect arM fhat the applipnt is a resident of Indiana and
on date application is fiied.
' Date (month, daY.1'ae�
autha'¢N person (num6er antl sbae4 ciry, state, and Z!P code)
Date (rtronth. daY, Y��
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