HomeMy WebLinkAboutMortgage_Doerner (4)^' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ , FOR DEDUCTION FROM ASSESSED VALUATION
$bta Fortn G3709 (R77 / Cr09)
�' RPSmbed Ey DepaRmeN ol �am Cao.erturieM Fuurce
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INSTRUCTIONS: �C7 t
To be l�ed in person a by mad wiNr the Counry Auditor w Counry Recorder o! the counry where the properry is kcat9A., I 1 F �
Filing Dafes: 1) Real Property: Must file durirg Ure yrear /or which the deduction is soughG Counry Auditw
2) Mobde / Manuladumd Homes not assessed as Real Property Must file dunng tha lwelve (72) mo�� �� Counry Recorder
6e/ore March 31 of eech year Ne deduclion is sought. d,� R✓
See'r9v8rsnside /ar adtlitional insfrucGons and qualifir,ations. /'� _,_ _ _ _ , _ „�.,, , , , _,__ �
Y t� ptoprsty as
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! lur e� share
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A1ptpage/ Contra�'udehtedness unPeid as ot MMgaqe / Cantratt mEeOtedne53 unDaiA az of Is M0 aPO�i tlIB sde
Memh 1. arm.nt ye�f� /� O�O date of aPP�� � o� o
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:t? tt owned xith someone dFrer Ihan spouse. indirate with whom
H name m remN's tliRemn Man Mat of appOCanc, hMirste belmr
Name of rtnrtpa9ee a mntraa sellPr
Md�ess d rt�gagex ar mntraG
awneror
(number aM atree4 uh, sl
Dces ePpliont o.m pnperty in any oNer
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u}y, 5ate. aritl LP mCe)
Dra�ser i\'O, adQc�
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Is Ihe O�VertY in 7uesGm: Mnua9y Asttssed
� Reel Pfopefty � ArinuallyPssesSed
0.bMle Fiortie QC 6
Has mm aeEU�o�, eee�, requ�t� a, proputy
for w�rent Y�n r--� .. r-i .
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O � Coun Date (mo/�p d�aY• Ye+f�� / �
I ry / V r/ �J�
ly 1 a _
of perju at the above arW foregang mfortnatim is W e and coRect and that Me appliran[ is a resident of IrMiana aM
weme � ed property on date ap�'zation is filed.
S." 7a0 5. Up��urd (,G}
futy exewted Power M Atbrt�eY a�' IC 67.1-12-0.7
person (number aM sbea; dry, stete. enC LP mde)
Date (r�h. d�y
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