HomeMy WebLinkAboutMortgage_Conklin (3)°•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T Year �
;. _— .
FOR DEDUCTION FROM ASSESSED VALUATION
Stala Fo�m 43709 (R71 / 6-09)
�' l Resafbetl M DepartrtieN o( Lnfxl Govemrtrent Fuwxe
� Fle Mark
INSTRUCTIONS: FE
To be filed in person or by mail with the CountyAUditor or Counry Rewrder of Ne county where Ne property is located. ��
Fil'mg Dafes: i) Real Property: Must file durnig Ihe yea� for which the deductlon is wughf. un ditor
2J Mo6i7e / Manufactured Homes not assessed as Real Property: Must file dunng [he hveNe (12J months
betore MarcM1 31 of each year the deduclion is sou�hG ^b Recordw
See reverse side for addiUonal inshuctions and qualifiwtions. G I BSON
DisVict
legal tlesciption
Recoid num0er Page nuMu
a(a - I -3s - oo -oo�. fT � � _ o a ,�
A real pfoperty es d Mo�(qage / Contract IntleDteEfress unPaid a N Mwtgage / ConvalY inOeMeMrss unDaitl as of Is Ne ePP��t tlx sole
yrar Ma`U 7, wrtent year date of appOtation legal w eQuitade wmM
/%/ �p/ a- ❑Yes ❑ No
/ her e�nd share of intrlest? tf owrre0 wiN someone other Man spouse, udirate wiTh whom
If name on rccorE a Aifterent tl�an that of aDP��4 �7��te below.
Name of mortgagee or contraU seller
aea� or � «�o-aa
counry
oeauc6o�
r�
5 ��3�
(number anC stree; tlry, slate, aM LP cotle)
w 35 - 3 - o
pioperty in any oNer If yrs, what munt�?
❑ Yes ❑ No
� m� a�w�� or
20_ 20_
nuartor . / • .
Is ihe property in puestion: MnuaDy Assesse0
.❑- Rea� RoaeAV ❑ /vmualN 0.�ssed
Moble Fbme (IC 61.
�— —
eo u Kc.c� , w�nh �
o � AG �� m �
What Tad(g Disirid?
NTY AUDROR I � 3 /� � �S/2
�# 1 i I(o I„��. �
20 � 20 � 20 � 20
certify u�er Ne penalty of perjury that the above and (oregoing information is We and cortec[ and ihat ihe appiitant is a resident of Indiaria a�
/ contract buyer of Ne atoremert[ioned property on date�plio�tion is filed.
rowrrers ha'nsme) o-ate (mwnb. ear, ree�
T
exewteA Power olAttomey w by IC 61.1-12-0.7
Pddmss of authoraed per'.m (numbera�M street, dry, state, and LP mde)
Date (monN. daY. Y��