HomeMy WebLinkAboutMortgage_Mason^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
FOR DEDUCTION FROM ASSESSED VALUATION
:• Sfate Fwm 43709 (R71 / 6-09) � (..((���
•�' ' J p��'py� yy pepartment of Local Govemment F�nce \` `� \
�"" J Fite a
isrRUCnoNS:
Fortn wi
To 6e filed in person w by mail with the CounryAUditof or Counry RecoNer o/ the oounry wAere the property is �.
Fifvg Dates: 1) Real Property: Must file dunng the year /or which fhe deduclion is soughG Counry Auditor
2J Mobde / Manu/actured Homes rrot assessed as Real Property: Must fi(e during the nvelve (72) months unry Recorder
6efore March 31 of each year the deductlon is soughG CC i1 �O�
�C H
See reversa side for adUitmnal insfmctions arM qualfirations.
I vdue d real aopertY az M
�mnt year
If ro, what a h's ! her erad share ot inte+est?
If name on reco�d
`z��
w oontraq seAer (num6er
!�`ICJCJ�WJ•1
/ Contract 4Me6tedness unpaid az of
� +e v
sba�, aM LP code)
assignee w othu owner or hdder of.nroMaoe_ __ _ ___
oi assignee (num6er and s(ree; c 1' �� I...11% i ����0
pli�ant ovm property in anY o�her I�l/�� A �
amount at
20
i� - �a8
20 � 20
�
mmeare
unpaid as of Is �he apptimnl Ne sde
kgal or equitaNe ame(1
❑ Yes ❑ No
Is Ne ryoperty in quesiion: Mnua%ASSesud
❑ Real Properry ❑ Armualy Pssessed
A
Has N's dedudion Deen
for ae2nt yea(.+
20 20
county
�r. r��
� D�WP+�Y
❑ No
20
1 I We certify under the penalry oi perjury that ihe above arM (oregoing infortnation is we and correct anC that ihe applinnt is a resident of IrMiana a�
owner I wntraa buyer ot the aforemerttloned pmperty on date appliration is filed. �"-"- -"-' �- �'
auihoiaed N,
'��-.C��'.1
antl street �Y, �te. antl LP mtle)
by
sbee( cily. sfafe, antl LP oode)
Date (mmN, tlay, yee�
Y