HomeMy WebLinkAboutMortgage_Doerner (5)- � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
FOR DEDUCTION FROM ASSESSED VALUATION
�• State Form 43709 (R71 / 6U9)
S PrPSaibeC by Departrtienl of Laral Govemment Finance
INSTRUCTIONS: �
To 6e Tiled in person a by mail with the Co�nryAuditor or Counry Recorder o( the counry where the property is located.
FiNrg Dates: 1) Real Pmperty: Must file during Ne year for which the deduc6on is sought.
2) Mo6de / Manufadured Homes �rot assessed as Real Property: Must file dunrg the twelve (f 2) monfhs
'� befae MaicA 31 of each year the deduclion is sought.
See ieverse sida lor additbnal instnrctions and qualilcations.
� Ko��`aeo i°4-�bo-bo�
i rPal popaty at of Mortpage / Contra� uNehtedr�s unpaid as
year March 1, wrrent karO �
/
m remd'a 6Rerent ihan Nat a/ aPP��t Mdinte belavr.
Name of rtnrtgagea or anUad seAer U l
Pddress of monpagee ar oontract seDer (nurr�6er and sLee; �y,
Name of
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Dra���cr \0.,. �V��.....
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FE� D ¢oipy�7(1uditor
� ❑ Counry Recorder
—•����. wunTY AUDITOR
�yumbv Page number
l oC��3 2,3��
Yes LI No
spouse, rtwkate w5m wnom
Is Ne property in question: MnuaAy AtisesuE
❑ Rea� P.oaertv ❑ lvmua�y Assessed
What Tadrg Districl? I Has N¢ deduCirn Deen 29ues�eE an P�W�Y
�, a�,em rean n..e� n �
zo i �_ i zo_
/�of� lC^� ,/v I Caunry I Date (rtmN, daY• Nea�
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I I We certify under ihe penalry of perjury that Ne above and (oregoing intormation is We and correcl and Ma[ the appiirant is a resident of Indiana aM
owner I conVad buyer of the aforementioned property on date applipdon is filed.
I�p���(oW�e/s �) �� Date (monfh. daY.Yge�
CWI rrsident adOr�ss of appfzant (number anC s7ree4 �ty, state, and Z/P code) ����
� �s��� �oos ���o eTZy IN
Pe1sw� Cy duly ezecuted Prnver al Attaney or by IC 67.7-12-0.7
/dtlress N auNU'sed person (number aM sbee4 �Y. sfate, and LP code) .
oa� p�w�. e�,:,e�n
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