HomeMy WebLinkAboutMortgage_Cloin^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year �
:__ _; FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fwm 43709 (R11 / 609)
�' ,,,� J Presaibed q OePa�N oi Local Govemment Fnance
I
wsrnucnoNS: ���uuu
To be filed in person w by mad wiN the CounryAUditor or Counry Recorder of the county where the propeAy is bcated. F��1 ��
Filitg Dafes: 1) Real Property: Must fJe dunrg the }rear (or which the deduction is soughL � 1���uditor
2) MobAe / Manufadured Homes rrof assessed as Real Property Must file dunng the tvreNe (12) months
betore March 37 of each year the deduclion is sought. ❑ n eoorder
See reverse side for adtlitional instruUions and qualfications.
MWl��"1(ownera conuarl6uYer�see restn'r,tions on rev�rse side) � .. _ �
Distrat
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d�aiptirn
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Recoid number
-lo/-000, 838-oa.d' �.oi3
dehtednPSS unpvd a N Mortgage / ContraU hMebteOrcess unpaid as d Is Ne a
Ea�e ot ap legal of
$ SD� [
If awned wiN mmeare otMl N n spouse. uM'rate with wMrn
tl narne on remtl is GAfrient Uun that ot aPP��t rtdirate 6ebw.
Nartre al nortgagee or con seDer
� r . oGz-a�u.�-.o F .0 . !,�
Address W mort9a9ce or contract se0er (nurtiber and street uN, s+ete. erN Z�P code)
Nama of assignee w
timN ovm pmperty in eny aNu
IMena? ❑ Yes
er of mortgage
ciry, slate, a ZIP catle_ )
,
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If yes. what muntyl
❑ No
Page number
Y� u No
b tlie pmpe�ty in a�saon: Mnuavy Assessed
❑ Real ProPertY ❑ NmuallY Psse�d
Moble Fiortre (IC 6
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