HomeMy WebLinkAboutMortgage_Kolle"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear �
__ FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Fwm d3709 (R71 / 6-09)
� � Preuribed M���M of Wcal Govemrtrent Friance
INSTRUCTIONS:
To 6e filed in person or 6y mail wrth the CountyAuditw or Counry Recnrder o/ fhe counry where the property is Iocated�A N
Fitirg Dates: i) Real PropeRy: Must file durirg the year lor which the deduction is soughf.
2) MobAe / ManWaGured Homes rat assessed as Real Properly Mus! file dunng fhe tweNe (12f month
betore March 37 0l each year the deduction is sayht. �-��
See reverse side for addifional inshuctlons erM qualifirations.
A�am(awrerorcorvrdC6uyPS' oora.ersesi0e) .% ..
I vaLe d real popaty as d
aneiv year
��nain�exaas+,�a�r�?
�1-3a-aoo-oo/. Y�9-o�l
Mpr(p�ge/ Conbaa "udehtedn�.s unpaid as U Mortga9e / Contratl
Mard� 1, airtem year date al aPP��
1f name on recortl e ddferent Nan Nat o( applkani,
Name m rtrort8a9ee or
nwrtqagrP or mno-aa
or dlmf owner w tmlder of rtnrt9age
bebv.c
aN. sbte. ard
speet dry. s1a1e, and LP code)
3� _ 3-tt a.a� a A
Dces aPptitant oxn P�DertY in any oNer I If yes.
mumyi���aana� r1 ., n ..
ez�
Sig�adae
�
I/ We certfy under the penal
owner / contract buyer of the
Ys fu0
.�sm
Is Ne appGtant tlie sole
�gal w epuitade ovrtieR
❑ Yes ❑ No
If owned wiN samearie ather ihan spouse, iMipte wBh whom
Is the property in puestion: MnuaOyAssesse0
� Real PmP�rt1' ❑ �n!u!alh/ Ass�sed
Dra�ser NO..a(�y
COUNTY AUDITOR
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�y8,ci�o ; 'co ............
zo_ zo_ zo_ �„_
Caunry Date (nmth, day, yea�
Nat above anA foregoing intomiation is we and cortea arW that Me appli�ant is a resident of Irdiana arM
ned rty on dete application is filed.
7 ��(0�/1���� \�1'•
II resiEen� d appfrcant (number anASLeet, ay, state. arM ZIP m
/575�5 (3�SE OAx'f+�✓Dc.
YSOn authoraed by EIAy e+ecuted Pwer W AttomeY a bY IC 6t.t-12-0.7
Address W auUmr'¢etl pe�son
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