Mortgage_Firkins.+�•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
,, . FOR DEDUCTION FROM ASSESSED VALUATION �
State Fwm d3709 (R8 / 2-07) � �
�O ;� '� Presaibed by Depahment of Local Govemment Fi�nce
INSTRUCTIONS: MA.Fi�e� �a 2009
To be filed in person or by mail with the CountyAuditor o/the county where the praperty is located. � r`
Fifing Dates: 1J Real Pmperty: Dunng the 72 months be/ae June 11 0/ the year the deduc6on is to be eflective.
2) Mobile Homes assessed under IC 6-1 _ 1 J: Belween January 75 and Maich 2 0/ the year fAe deducGm is to`-¢e;�g� ��
See reverse side /a addifional instiuctions arM qualifications. , ��`
I �
Applicant (owner �� e� �ons o.� reve siCe)� /'� 1�'l .l n`n� �
f\I t V A\ 1 11/
V 2-av'�- \7 ll AC
,�..� I � �4(0-13-3o-loQOOO,o3y o�� I - -`
ralue of real propsty as d March 1, aarent year Abrtgage / ConUaq indebledness unpaid as M March 1, Is Ihe appficant Ihe sde
anem year �/, _ �� .
If name on record
Name of moMgagee or cantrdcl seller
Address of morlgagee w mntraq seller (number aiM 5reel, dry, stafe, and
owner w
Address of assignee (m�mber aiM sLeet. tity, state. arM ZIP ooOe)
Does applicanl own proparty in any dher
courrty m Ind'una?
❑Yes ❑ No
duction appioved in the amount of:
�1 '
/�
t re Autlilor
I/ We certi under e enalry
hdiana and owner o e afore
Fu0 ravdent address of applicant
��- v9.� C- <
e�n aulhorized 6y tluy execul
Address of aulhoraed persdi n�
sameane dher Ihan spouu,
x equitable wvneYt
❑Yes ❑ No
Is Ihe property in Questlan:
❑ Real Property ❑ Mobile Home (IC &1.1
If yes, whal counry? ested on p�aperty
Di•a���er \'O 9- 9a� �Yes ❑r,o
20 _
cauN, . Card i1'
O .. .....:..:...
00
p_� 3� `�� � 3c�. Zo
Cwnry
Date
l� i V --� ' V
of perju t fhe above and foregoing intomiation is We and mrrect and ihat the applicants was I were a
nention operty on March 1, ZO
a . Date (monih. daY. Y��
�r and s(reet. cdy. stale, arM ZIP cade)
-o E
wer of Atlnmey w by IC 61.1-12-.07
�. �%J�v �
entl 5freeL cAy. SIetB, M LP o008)
Oale (mon(h, day, yee�
o(