HomeMy WebLinkAboutMortgage_Dunkel (3)2n STATEMENT OF MORTGAGE OR CONTRACT INDEBTE S co Township vear
__ _; FOR DEDUCTION FROM ASSESSED VALUATIO� �
Slate Fortn 43709 (R11 /6-09)
�' ,w , Presvibed by DepartmeM af Lod Govemrtrent France
4 2 File Mark
wsraucnoNS: FEg i
To 6e h7ed in person a by maii with the CowtyAuditor or Counry Recorder o/ the counry where fhe property "s . F� �� ��
Ffig Dates: 1) Real Property: Must file during the year for which the deduclion is sought. • `j � Counry Auditnr
2) Mobde / Manufaduied Homes rrot assessed as Real Properry: Must file dunng
before Ma�ch 31 ot each year the deduclion is sought. C�UN Counry Recorder
See �everse side 7w additional instrucGOns and quafifications. ('j1BS�N
Aodcant (awirer aowitrsCbWer - see rentdcfions rn revarse sidef'1
Y�
Keyrwmber/legaldescnption
- 4s-e i 5- vo �- 36 I- C5� /"
�age/ ContraG'uWebcedness unDald as W Mortgage / Contrar] indebtedness unGaid as d
i 1. artent year , tlale of appGCation
name m recartl n EitFerrnt Nan Nat ot aPpfranL ��� �low.
amP�of morigagee a mntrar� seUer
mntrad se0er (numEU arN sfieeL �Y. state.
(numDer ana suee{ ary. srate, ana c�r coae)
ty in eny oNer I If yes. what wunty.+
❑ Yes ❑ No
/_ �', — / ..� / r
Deducoon approvetl in �he amoun
20 20
Sgrewre d CounN A�Witor
Page numbrl
5 // �
� � U Yes �J No
If owned vriN someone dher ihan spouse, iMinte with wtwm
(Is�fh�e,p,�roperty in puestion: MnuaOy Assesud
�� RoPertY ❑ Mnua��Y 'Asstssed
Mod7e Fbrtie QC 61.1-�
�C.! ti��� - _
. /,� �, �
Wha1T: /�� �/I�
20 � 20 � 20 � 20 � 20
I/ We certify urWer the penalry of perjury Nat the above and foregoing infortnation is We and cortect and that the applirant is a resident of Indiana aM
owner I contract buyer of Ne aforementioned property on date applicabon is filed.
nqCUe (o h� rmaml _ /1 Date (rnmth. daY. Yae+l
VU
exewtetl Poxer oFMOmeY or by IC 67.7-12-0.7
Address of authwaed pelwn (number arM sbee; cify, state, aM LP mtle)
oa� ��r�wnn, aa,: r�n