HomeMy WebLinkAboutMortgage_Bostick'°'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
__ � FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 03709 (R71 / 6-09)
,' ReSbibeO M�Pa�^� ol Lxal Governmetrt Fvance
File Mark
INSTRUCTIONS:
To 6e filed in person or by mail wiN the CounryAuditor or Counry Recorder o1 the wunry where the property is located.
Fiting Dates: 1) Real Property: Must fde durirg Na year /o� which the deduction is sought.
2) Mobde / Manufactured Homes rrot assessed as Real Properry: Must file dunng the lwelve (72J months
6etora Ma�ch 37 0/ each year the deduction is sought.
See reversa side 7w adtlilional inSLUCfbns and qualificalions.
Appfi�nt (o�r w convau Duyer - see reshc0ons cn re`ers�siie)
uimEer I legal
-.�n _
4 mal p�opttty as
Y�
If name m �emd'e WRerent Nan Nat of aPP��L mdi�ate bebv`
Name of rtnrtgag� m m�trarl seller
Addtess of mart9a9� or cantraci sWer
awner rn ndaer ot mortgage
County Auditor
�Q�unN Recader
m Record number Page numCri
- o�vo -Do/ �/ l 5- o o/ 0 4 oS�
act inde6ledness unpaid as o( Mongage / Contraci inEebteEness unpaid as o( Is ihe apprcsnt the sole
year date ot appGption legal a equitaNe mme(1
il �� n Yes n No
� �
stafi, and LP code)
If wmed with someone other ihan spwae,
Is Iha pfoperty in 0���: �nuaPj Ass¢ted
❑ Real Property ❑ Armually Assessed
bloWle Fiane (IC 61.
Drativer NO...P��C�...... .
Card NO. ....�� ��......
Pd7`ess ot assig�ce (number aM slree4 �y, slete, and LP wCe)
� Z�O,�o. -- -
Dces applit�ant ovm propeM1y in any oNer If yes. what munty? What Tanng u�svua. _ MoV'�`/
munryinlndana? IlorartentyeaR � Yes_
❑ Yes ❑ No ❑ No
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