HomeMy WebLinkAboutMortgage_Mersinger�
X
^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship vear
__ • FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Fortn 43709 (R71 / 6-09)
� Presaibed by DepartmeM ol Lnml Govemment Friance
� � �� e a
INSTRUCTIONS:
To 6e lled in person or by mai/ with the CountyAuditor or Counry Recorder o/ fhe counry vfiere the pro �s ! �
Fi6rg Dates: 1) Real P/operty: Must file dunng the year for which the deduction is sought. . � Counry Auditnr
2) Mobile / Manufactured Hanes rrot assessed as Real Property: Must file dunng the fwefve (12) ipppt�' n o �O ��
betwe March 37 of each year the deduclion is soughG U t �� p Counry Remrder
See reverse side fur edtlitional instrucL�ons arM qualfications. ^
�. App6ranl(owneror convart buyer- see restncfions m revzrse side) . l _
ey nimEU I legal desaiptim // U 16J V IY hil7ii NEr" '"`Page number
�ox� ���o�-00% ya3-o.t �,o�a- l07 ..
Y rral p'operty as ot Mor�age / Cantraa inde6tedness unptitl as W Mortgage / Con7aC indebtedness unpaid as d Is Ne aPP�t the sde
ypr Mamh 7, anrent yenr date of appGmtion legal w epuitaWe avnell
7 � ❑ Yes ❑ No
I IIP.f 0Y2tl Sh22 Oi If1IPlP51? �( PM1Bd WIN SOrtI¢OIIC dhH fI 5Qd150. pld%228 WIIh Wh0fi1
�
It nane m recortl a C'iituent lhan ihat W app6ranl, mdicate bebw: Is the propem� in Quesum: MnuaAy AssesstW
C�d'R� �aenr ❑ nN,��!r a�a . . .
ot rtbrtgagee a mntracl seller
Address of rrort9agee w mntran seller (numbrs and saee4 ��', sfate. aM ZIP oode)
Name o� assignee w other owner or hdder of nqrtgage
AAC�ess of assignee (number aM sbee4 uN. sfala. and LP cotle)
fiCaN wm property in any dher
����
❑ Yes
,-�:^
'��
sg�n� or c�,a awe�
I If yes. whet munty.�
No
couNn
I/ We certify under ihe penalty of perjury
owner I mntracl buyer of lhe aforemeritic
20
above z
�eM an
Di•a�ver NO.�/ �
What Ta�rirg D'siria? . / • ••• ..
Card NO. ...�? �/ �
auoRaa W �o% 7� ro'...
, � -_
zo � 20 � 20 � zo
U=ra
fegning infortnalion is We and cortect and tha[ the applirant is a resident oF Indiana arW
applinbon is filed.
Data (rmifi. tlaY. Y��
tiry, state, aMLPCOtle)
AOtlress ot a Wmmed persa� (number arM sbee; ciry, state, aM LPmde)
(rtronlh. tlaY. Y��1