HomeMy WebLinkAboutMortgage_Sisk (5)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTED� n Township Year
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� FOR DEDUCTION FROM ASSESSED VALUATIO� �
' • State Fortn 43709 (R71 / 609) �■'�
�' ,,,, � Presrnbed D! OeG�N of Laal Gorerturrerit Firw�ce 1
iNSrRUCnoNS:
DEC 312U13 File Mark
To be fifed in erson or 6y mad with the Coun Auditor or Coun RewNer ol the county where the Fortn Aed wim:
a N b wovertyisrocated
Fif'vig Dates: 7) Real Properfy. Must fJe during the year for which the deduction is sought County Auditw
2J MobAe /Manufadured Hortres irot assessed as Real Property: Must fJe dunn ' nths
6elore March 31 of each year the deduction is sought - AUD�TOR C�unty Remrder
See reverse side fnradditional instructions and qua�ifications. GI860N COUNN
MP�a�� (0�� or contraU D✓Y�- see resf7�D� m reverse side) �—' � �
Mazd� 1, nereni yeer
If ra. whal Is lils! her erxt share Of interrst?
Ii rume on 2mtl's GiR�t Oun that of appBmn; trd'vate hebw.
Nartre of mortBa9ee
'F :ia
w othel ovmer or imider of nwrtgage
P.Ldren af attig�ree (number aM svee4 WY, s+a1e, aM LP cade)
Does epplitant wm pmperty in any oNer If yes, what counp//
ca,ntyi���aiar,aa ❑ ves _
❑ No
20
�9��
Reco�d numbc
��
M owned with someone oNer Nan spouse. IMicate wtth whom
WhatTa�dng Datri
20 I 20 1 20 I 20
Yes ❑ No
Is pmperry in que�tion: PnmiaM Assesed
�Real PmpertY Q {vmuallY A�sed
��..�.a„ u.....e nr a
�
`�1 ��__
yuvu,�=
Ug - ��9g
20 _ � 20 _
��
I/ We certify under ihe penalty of perjury that Ne above aM foregoing infortnation is We and corteG and that the applirant is a resident of Indiana aM
ovmer I mntracl buyer of the aforemerrtioned properry on date application is fiied.
I^af��e (ownuS h�rmme) . � \` Date (rtmtli. daY.Yea�
sbeet
w
Address of author¢ed person (numbe� aM sfreet ciry, s+ate, aM ZfP code)
. . ' Date (monN. daY•