HomeMy WebLinkAboutMortgage_Buck^�� STATEMENT OF MORTGAGE OR CONTRACT INDE
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
Slate FOrtn C3709 (R71 / 609)
�' PresaibeO M�M oi Local Govammerd Firence
,�
Cou vear
F'eM
INSTRUC710NS:
Form ed wNh: '
To be fifed in person o� by mail witlr the County Auditw or Counry Recn�der o/ the county wheie the property is located.
Fil"mg Dates: 1J Real Property: Must file during the yearlor which the tleduction is soughL � q�d��
2) Mo6ile / Manufadured Homes rrot assessed as Real Properly Must file during the hvelve (12J months ❑
befo�e March 37 of each year Ne deduct;on is sqyht. � �
.'iA:DY.hSi�Y:
See /eversa side 7a additional insfnictions arW qualificateons.
MG�m�I (A��iPr conhaa 6uyer- se�resLir�ons m rewse side)
sed rahie d real D�ap�Y as of
il,armrty�t
what is his � her rsar2 share a
ie m iemd's QRferent than If
r of mutgagee a cono-actfell�
rvamaa� asvgnee w w�er o�vner
Keyrwmbul
U' G L� !/ �O / Uti U ' �O
MMgag e/ Conlraa irdehtedn�t unpaid a d Mortgage I ContrarY mde6tedness �mpal0 as of Is Me appRrant Me
Mafth 1, arteni yesr tlate o( app�CaUOn kgal a epuitade owneR
�,��^�j ❑ Yes ❑ No
IF awned wiN somea�e oNer than spouse. mdKSfe with whan
S the ProPe�Y in Guestion: Mnuaoy AssesuC
� �PBKY � Armua�lyAssesSed
seder lnuiMr� end sbeel, rAy, sta.e. and ZIP wde) '��
rn holEer d rtprtgage 1'`--'�- /\/ �,(/ ��
sdeeG �: stete. arM ZIP mQeJ m� I n / n� �� �"�
� L ��
m�n poperty in any oNer � If yes, what
ueauam aDW� m u�e amwru or.
�
SigreWre N Goimb AuEitw
No
COUNTY nu.... _
�ested m p�opvty
��l D ' S910 � � Yes ❑ Na
20 _ � 20 � 20 _ � 20
County
20 _ � 20
Date (rtpnN. CaY.
I I We certify under ihe penatty of pe�ury that Ne above aM foregoing infomiation is We and cortect arM that Ne applirant is a resident of IMiana aM
owner / mntracl buyer of ihe atorementioned pruperty on date aPplication is filed.
I��9{ownefs NO reme) � .. Oate (rmv�fh. tlaY. Y��
revdent a0tlmss W
3i/r9S s
tlty, Yate, eM ZIP Code)
o� (rr,avn, nar. r��
Atld�s of aWw'ved puson (num6er aM sbeet �: s+ate, and ZIP code)