HomeMy WebLinkAboutMortgage_Mason^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count
• FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Form G3709 (R11 / 6-09)
� l Presaibetl by Departmerit af Loml GovemmeN Fnance
INSTRUCTIONS:
b 6e filed in person w by mail wiN Ihe CountyAuUitor or Counry Recorder of Ihe county where the property is located.
Filirg Dates: 1 J Real Property: Must �le dunrg the year fof which the detluclion is sought
2) Mo6de / Manufadured Homes rat assessed az Real Pruperty Must file dunng the hveNe (12) months
6efore March 37 of each year the aeduclion is sought.
See reverse si0qfor additional instructbns and qualificafions.
7a�un9 Oistriri , � d� ���l0 1 J� J O D r
�4a�e�s`sed vahu dmal qapsty aa ol ot[q ge/ ContraG irde6tetlness un�
�o�t.qimrtyrar Mard�al.wrtentyWr
wt is his I her exad share ol intemst?
m 2mN ¢ drtferent ihan Uat W appGran4 mtlinte Celow
tt awneC with
� aoun�R��er
/ Cmract mEebtetlness isGaiC a d Is Ne aOP�t tlie sak
p�1on �al a equftatle ow+u(1
� �D ❑ Yes ❑ No
aher ihan spouse, iMicate Wih whom
Is Cie propnm� in pues6on: MnuaDyASSessed
� Reai Pfoperty � Armually Pssessed
Modle FWrt�e fIC 61 J-;
Name d rtartgagee or mntracl se�er ,�
Addrces W rnorlga9ee or contraU se�er (numbri erM sfree4 �'. stafe. arN oode)
Name o� azsi9nee w oNer owner or halEer of mortgage
ALtlress of assignee (number eM strae4 �: slate, an0 Z/P m0e)
oces epd�.m wm waa�r in am� oWer �r y��YjU-� �'' Q��+r T —
^"' " �dy8.'�.........
oou in Ind�ana? ❑ Yes ❑ No
T
Has iha deduGion Deen 29uestetl m P�Y
br a�rtem yPaR ❑ Yes ❑
prauction appmved in Na amount ot. � •
� Card NO . .....................
zo— \�y� �°- mASo,� ��5 r �o�-Gls� �_ �_
�� sN�R�� L
sy�uwre a co�ry n�ert�r \ -- � oa� c�un. ear. r�d
I/ We rtfy under the penalry of perjury that the above and foregoing infortnalion is We and cortect aM that the applirant is a resident of Indiana arW
I contract buyer of Ne aforementioned property on date application is filed. �
� Wra�xrreYs hA�me) .. � Date (monU�. EaY•.yve�.
..e+ .�� � _
D vv �r – – -
Pelson autlamed �y duly e�eated Power otAttomeY � �Y IC 67.t-t2-0.7 �� (�N. �Y• l'ea�
fdtlress of aNhoraed perswi (number aM sneet �Y. �re. arM ZIP tade) .
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