HomeMy WebLinkAboutMortgage_Plumer"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun'
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fartn 43709 (R77 / 609)
�' j P2svibetl by Department of Local Govemmenl Fnance
�u.
INSTRUCTIONS:
To be lled in person a by mail with the CounryA�dito� or County Recorder o/ the oounry where fhe property is located.�
FiNrg Dates: 1J Real P/operty: Must file dunng the yearlor which the deduc6on is sought.
2) Mobde / Manufactu2d Homes rrot assessed as Real PropeRy. Musf file dunng the fwefve (72J months
betae March 31 01 each year the deduction is soughl.
See reverse side fur addifionel inshuctions and qualilcations.
MP��t (uw6ar frcontarl buyer - see restritbw�s m B e A n
oiso-ux
wt�at ts his / her e�ae share ot interest7 "
�e on �ecwA o Eift�t Nan Nat of aDP��L md'uate below.
,�qyp udilor
i %II
`Cd�tt ecorder
� BSON COUNTY AUDITOR '
� •�� O� Reco�d nu Page number
� O 1 10
I"vWebtedr�s unpaid az W Mortgage / Cmtracx uWebtedrress unpaie as oi Is Ne ePPr�� �he sole
U dale of applica[ion legal or eQUkade owneP
❑ Yes ❑ No
If ovmed wiN somepne Wher Ihan spouse. indirate with wtqm
Is Ne property in 9uestion: MnuaOy As5e55e0
� � Reel PrOPeKY ❑ %umu�' Asse�d
nnow� rio� nc ��.i-n
Name W rtahga9ee a mntract seller �
�E
Add2ss of mort9a9� w mntract seDer (nim6er and street cdY. stete, arN LP wde)
r,ame a� assgnee w omer owner or naaer rn mortgage
AACress ot assignee (number erM shee; dry, slate, arN
�oes appumru ow.� wov�r
m�nryml�Wiana? �
D�LUCtion appmved In �he amount of:
20 20 _
Sn7�nne N Co�mry Aud'rcar
I/ We cert'rfy undu the penalry of
owner I�ytntract buyer N Ne afon
��
r;'
Dra�ver NO. ��/�.........
Card NO. ...�O.y�.........
� ► l�, oc�D. °-
s lhis tle0uctim Deen requesteE m pmprny
c�nern rear � . _ �
20 � 20 � 20 � 20
ICounry I Date (manth. daY. Yza�)
Nat the above arW foregoing infortnatlon is true and correc[ arM Nat Ne applinnt is a resident of IMiana aM
ned property on date applicatlon is filed.
Fup re5i0ent address of appfimnt (num0er end sbee4 tily, sYdte, arM LP cd
Puson auttwr¢etl by dity exenitetl Pox�e� W Attomey or Cy IC 61.1-12-0.7
Pddress of author'¢ed person (numMr arM sbee{ ciry, stafe, arM Z!P code)
Date (rriMfh. d�: Yee�
�
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