HomeMy WebLinkAboutMortgage_Hulfachor^�� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
_. + FOR DEDUCTION FROM ASSESSED VALUATION
� State Fam C3709 (R71 / 609)
�' Prescribed by �epartmenl al Loral Gavemrtrenl Fnarxe
�«.
Coun Tawnship r
File Mark
�STRUCTIONS:
be filed in person w 6y mail with the CountyAUditor or Counry RemNer o/ the counry where the property is located.
Filirg Dates: 1J Real PmpeRy Must file during the yrear for which the deduction is sought.
2) Mobde / Manufactured Homes not assessed as Real Property: Must fiie durirg the fwelve (12J months
befora March 37 0/ each year the deduction is sought.
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See reverse side for additional insWCUons and qualifications.
�a�����o�
Maich 7. ammt Year
�i 110. W�1d16 �15 / �12f BY2f2 SiNR
m
mort�agee or contrarl seVer
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�
rsaiption �/ Remrd number Page
- 00 -Qd . O � S-o6 / // QO
r/ Contrarl indebtetlnass unpaid as af Mongage / Canva�t inEebtedness unpaid as of Is Ne appircant Ue sole
curtem yem aate o( aOP�� legal or equitade owneR
❑ Yes ❑ No
If owried with someone dtrer ihan spouse, Irdicate with wtqm
Eebw Cie V�P�Y in qunstion: MnuaDy AvesseE
�Reai RoPenY ❑ �^�Y �
� Mobile Hortie (IC 61.1-i
Mdmss of matga9ee or contrar] se0er (mmDri and stree4 �y. state.
Name of asignee w oNer awner
naaress
beant wm propPlly in any olher
Indgta?
❑ Yes
appraved'ui Ne amount of.
20 � 20
SignaMe of Camty Audiiw
slate. and Z/P code)
If yes. wha� muny?
I No
I 2(1 I
'�^'^" `0�
— - - �p�}4/�b2
- N�'�'��Nv�,A�'`� :��,P�
_ � Yes ❑ N
�U
I' J 1
20 _ 20 20 20 _
Date (mamh. tlay, year)
I/ We certify urWer the penalry oi perjury that the above aM foregang infortna�ion is We and correct arM that Ne appliran[ is a resident of Irdiana antl
owner 1 mntracl buyer of the aforementioned property rn date applicatlon is filed.
IL�Wre (��'Pe� �^4�) . _ Date (nmM. EaY•Y��)
e��wc�a ao.�r oram�r a or ic �,.
Pddress of authoraed persm (numberaM snee; ciry, sta(e,