HomeMy WebLinkAboutMortgage_Sisk""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court
_. • FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R71 / 609J
,,' y�. I Presrn'6ed by Departmern at Local GovemmeM Finarce
INSTRUCT70NS:
To be fited in person w by ma�l with fhe CourttyAWifw o� Counry Recorde� of the counry where fhe property is located.
Fifi�g Dates: 1 j Real Pmperty: Mast file dunng the year (o� which the deduclion is sought.
2) Mobde / Manuladured Homes rrot assessed as Real P�operty: Must fiIe dunng the hvelve (12) months
6efore March 37 o/each yearthe deduction is sought.
See reverse side !or additional inshuctions and qualificafions.
App�nt (owner orcontraC 6vye�- see restncbons on reverse siQe) _ �
TaGrg Distrirl / TT Key �uunber / 1e9a1 Eesoi7tbn
� -ob �
Asrssed ue of rral erty es N Mor�qaga / Contraa 4
Madi 1, rreN year Ma�rh 1 artent yeer
tt m, what Is his / Mr e� share of interesi?
if nama m �emrd'a 69ernnt lhan Wt af app6�ant, cM'xate Eebw.
ar aantrari seller
ACdress of mortga9ee w contraq seller
Name of assignee or other o�mer a twldar ot mwtgage
�%
riry, s/ate, and ZIP catle)
-3-�► �. y a. �+�
' If yes, what county7 NTaI Ta�d'g I
Year
Counry Aud'ROr
1 O�unty Recorder
r�p numba Page numbPi
-O,L d�o(�- S70
e/ Contrxt iMebtedness �mpaid as d Is Ihe app�nt the sole
ippOtation legal or equita6le owneYl
�p7 �S(� ❑Yes ❑No
eone o �han spouse, hidkate WiM wham
la P�GP+b m question: Mnw
�PenY ❑ hbWle
Dra�►�er i�'0... °�/�
Card Np. ,,,,.570
......� ......
� �(�7, �r 5c). �
couNrrnuoROR
oeaucuan appmued tr� me ama,nc of:
20 _ 20 _ 20 _ 20 _ 20 _ 20 _ 20
Signa W Co�mbAudibr Caunry Date (monfh, deY.Yea�
I/ We certify under the nalry of perjury that ihe above arW foregoing infortnation is W e and cortea arid that Ne applirant is a resident of Indiana and
owner I mntract buyer of the a(oreme�oned property on date application is filed.
\' Slgre wneYs fiA reme) -. Date (mw+fi, daY. Yme/)
�\ D
Fu0 dant eddress of appOnnt (numberarH sbee( aty, state, end LPCOtle)
(va w '{7ss owE,vsva��F �'.v K% (oG�'
Pe�son autho�rseE by duly etecvted Power of AltwneY or by IC 61.7-12-0.7 Date (rtpnN, dey, yee�
lbtlmsv of autha¢ed person (num6era� snee4 �; sfate, en0 LP cotle) .
\