HomeMy WebLinkAboutMortgage_Buck (4)"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
: FOR DEDUCTION FROM ASSESSED VALUATION �
� Stata Fortn d3709 (R7116-09)
�' �«. Presmbed M DePa�rrt of Lmal Govemmem Frenca
File a
INSTRUCiIONS:
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To be filed in person or by mail with the CountyAuditw or Counry Recorder of Ne aounry wAere the property is located. � U F
Filing Dates: i) Real PiopeRy: Must file dunng fhe }rear (o� which the deduclion is sougAL � Counry Auditor
2) Mo6de / Manufactured Homes not assessed es Real Property Must file duririg the fweNe (12J maiths n'
6efore March 37 0/ each year the deduction a sayhG �� l{,f j,�unry Recorder
See 2verse side /oraddifionel insfructlons end qvalificafions. (31BSON COUNT
Appfcam (owner or,e6�anc 6^uye^rM- see on re side) �Ll i
, � �lJV 0/
Assessed raWe d� property as of Martqage / Cont
MaRh 1, a�mrt Ker MBT�, Ly(Rfll
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K lq. N'tt2� �5 �IS /�IEf P.NJ' f2 5�12R 01 UIiPlCSI%
If fwne m remN b 6.Re2nl tlan Nat af app6mnl, trMirata belrnr.
name m rtnrtgagee u
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3
name m assgnee or omer owner w ro�oer rn mongage
naaress o� amgnee �nurroer ana suee4 �1: �e, ena ur coae�
ooes ap�m w.,, v�rem ��,Y om� u,�. �
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D�uGion approvad in tha amount of.
300 C�/ .
IndeMedness unpaitl az
300 �
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SORICOfM dllEf V121I SPOlISC.
numbu � Page numbrl
irtade awnell
Yes ❑ No
peny in Question: MnuaAy Asses,eM
PropertY QMnuallYAssessed
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20 _ v�) ��20 20 _ 20 _ 20 _ 2q 20 _
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SigreGae of Camfy AnEttnr Counry Date (rtpivh. daY. Y��I
I I We certify u�er Ne penalty of perjury that !he above and foregoing mfortnation is We and corte�Y arM that the applirant is a residerrt ot IMiana aM
owner I contraa buver of the aforementioned property on date appiication is filed.
FWI ent address of appfrcant (numDer anE sLee4 �+N, ��e, and LP
?� b '74 E ,��OS �Ya�la� �
Pe1sm autlaReE Ey dWy exewted Pw�er a(Attomey w Oy IL 6.1-t2-
ew
AACress of aWiormM persm (number and sbee; �; slale, and LP m
Date (monN. daY.
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