HomeMy WebLinkAboutMortgage_Head (3)•"�a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
� FOR DEDUCTION FROM ASSESSED VALUATION
.• Sfate Fortn 43709 (R11 / 6-09)
S � p�¢�ip¢p by Departrtrenl of Local Govemment Finarxe
�e
INSTRUCTIONS:
To be filed in person or by mail wiG, the CounlyAUdito� or Counry Recorder o/ the county where fhe property is located.
Fifilg Dates: 1) Real Pmperry: Must file dunng the year Por which the deduction is sought.
2) Mo6ile /Manufadured Homes rrot assessed as Real Property Must file dunng the fweNe (72) monNs
6efore Ma/ch 3l o/ each year Me deduction is sought.
See reversg side fnradditional instructions and qualifications. GIRS
L.'��3'JjE
Counry Audimr
Key fwmhel / legal desaiption Rem(d num6rl Page nuMer
-ac�-iy- �03-000,oq7-Oo oi S�
of Mortgage/ ConbaG IntlebteO�ress unpai0 az af Mortgage / Con'rad indebteMess unpaid as d Is Ne eppfirani Ne sok
March t. cvrrenl year date ot apPGratnn legal or equlta6le oxneYl
`a. �j nn(� ❑ Yes ❑ No
If ro. what Is his I her euG �are of interest?
If name on re�ud
rtnrtgageeorcontraciseller �
T F�C
o( mortgagee or contract seller (num6er and sfree; cip; sfate,
Name of assignee w other wmer or holder �
Addmss ot assignee (number arN sheef, d1
P-r 5� N�
Does ePplimnl own property in any oNer
munry in IMata? ❑ Y2S I
DeducCOn appfmn.� In Cre amount of:
20 _ 20
rtprtga5e
sfate aMZlPcode)
1`{-3.�
If yes, wha[ i
No
I N
, �8 A- c�
What Ta�dfg D'a�
couNrrauoROR
20 I 20
Is �he DroGenY in questim: Mnually hssesseE
�eal Pfoperty ❑ Aruiva0y Assessed
., a., u.....,, nr c
Drawcr \'0... ��l v�
. .........
c���d �ro. ..,�.[....��3�c�...
, `i�5��b�.GL�
yea�
`I We certfy ulWer Ne penalry of perjury that Ne above ard foregoing intortnation is true and correct arM that Me appiipnt is a resident of Ind�ana aM
oxner % contracc buyer of the aforementbned property on date appfication is filed.
I�y�n �a ) // /% Date (rtmM. daY.Ya�
dll: sfate.
(month.
of authoraed prJSOn (numbe�aiN sDeeG m}: sbte, ard LP code)