HomeMy WebLinkAboutMortgage_Haley (4)^� STATEMENT OF MORTGAGE OR CONTRACT INDE
__ , FOR DEDUCTION FROM ASSESSED VALU�ON
• State Fwm 43709 (Rt1 / 6-09) ��
S P�esaiCed by Departmen� ot Laral Gorernment Fna�xa �L
�«.
INSTRUCT70NS:
b 6e �led in person or by mail with the CountyAuditor or Counry Recorder of fhe oo �
Fdirg Dates: i) Real Pmperty Must file durirg the year for which the deduction is
2J Mo6ile / ManuFactu2d Homes not assessed as Real Property Must fiIe
before Maich 37 0/ each year the deduction is soughG C.
See reverse side for a�dito9nal inshuctions aryd qqal�cations.
AppGcant(ownerwoon cf uXer-see vef,Za d) n I N 1
f rea� pmPem/ es
Y�
It i+0. wna15 ns / Icef e�a snare ot mteresT!
If name on remC's EiRerent Nan Nat o( applicant, uMicate bebw:
Name M mort8a9ee a mnvatl uller
Address of mort9acJee w mntrxt se0
Does�
counry
�
�
� ��� � m
�
ia-5�a�
20_ � 2f1_ � 20
I I�certify under ihe penalry oi p6}jury Nat the
owner / mntrad buyer of the afrnementioned pro
20
BTEDNESS Coun Township Year
� �.J File Mark
Form filad :
�^�^Ye�^������.
�t. County Auditor
dunng the hvelve (72) months
'�.IYV�;�,�, ❑ CounryRecorder
(� �
d� Ak
What Taring DisIriC7
20
Record Page numbu
� S� a
�mPaid as d Is ttre ePO�t the sole
iegal w epuitade wme(T
❑ Yes ❑ No
SPWSC. YMICdi2 WIQ1 Yltlofll
Is ihe propeM �n question: Mnualty AssesseE
❑ Real ProPenY ❑ !�!?�!�Y�
Has �his deduGbn
mr an,em year.
20
� P�Y
20
�.M.,,,Y .a��o,�,... � ��,,,M.�.��= a � -��,
regoing infortnalion is true and cortec[ aM that the applinnt is a resident of Indiana aM
applin4on is filed.
F �esi0ent eEdr�s d app(irant (numDer aM stree( dl}; state, antl LPCa
97�y s w���
Prlson autfw�¢eE Dy duty exeated Power otAttomeY or by IC �1.1-12-0.7
Pddress of auNOr'¢ed person (num6er arM sbcet, cAy, state, aM LP co0e)
�y