HomeMy WebLinkAboutMortgage_Broshears STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION r rp®pp
.- Form State Fo 43709(R11/6-09) 2l[I
Prescribed by Department of Local Government Finance
INSTRUCTIONS: �d
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Fn I ZU1U
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months �❑
before March 31 of each year the deduction is sought. �JL//JCOU ecorder
See reverse side for additional ins s and qualifications. q��
t( or iced buyer-see /ber/l al e%�crip' �\ \ (GISEC Tf AUDITOil
iSvalue
' Q y n m l desrnnbon / n �v�5AA Record number Page nu
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of real pmpaty as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the apprmant the sole
current year Mardi 1,current year date of ap legal or equitable owner?
r?❑ Yes 0 No
If no,what Is his/ exactshare of in If owned with someone other than spouse,indicate with whom
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If name co record is different than that of appbcand,indicate belay. ` _?./�/ a' \\� Is property in question:Annually Ace ced
y/"7 /J 1r, y? ,chi'�� eel Property ❑�lemHome�(I 6-1.1-7)
Name of mortgagee or contract seller (__. /� � / /\�' 'IV( fl
Address of mortgagee or contract seller number and ~`( st�f,oily,state,and ZIP code) ��
Name of assignee or other owner or holder of mortgage I•'
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Address of assignee(number and street,my.state,and ZIP code)
Doe (`jj ing District? Has this deduction been requested on property
coin 41OQ-aL -.�—�awnJJ���ign for current ❑ Yes ❑ No
a `Jt c t
Dad ` , /
�6 h 20 20
tSR y yg, Date(month,day,year)
elarr-
I ve and correct and that the applicant is a resident of Indiana and
t Jr / Date(month,day,year)
'�y, 000. �'
Fug I
1 Pei a 010 — s Date(month,day,year)
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