HomeMy WebLinkAboutMortgage_Page (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship vear
_,_ = FOR DEDUCTION FROM ASSESSED VALUATION
• Sta[a Fortn d3709 (R11/609)
�` ,�,� � Presoibed Ey Departmenl of Lwal Gavemrtrent Frence
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INSTRUCTIONS: p�u��ed�ph
To 6e filed in person w by mail with the Co�ntyAUdiro� o� Counry Recorder o� the counry where the pioperty is located. F I 1 t. t, J�Q 2��9
Filirg Dates: 1) Real Pmperty: Mus( 61e dunng Ne }rear lor which the deduclion is sought. �� Counry Audimr
2) MabAe / Manu/actured Homes not assessed as Real Property: Must file dunng the fwelve (12) months
6efore March 37 0/ each year the deductlon is sough[. - �����e�
� �a
Sea reverse side (or additbnal inslrticUons and qual�cations. V �
Aooficam (owrera,cmtrarl6u�er- see resfii'bons rere+se sCe)
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M2iCh 1. anerrt year
��J v
r I legal dewiptan
�-1�- - �- .5�
ge/ Conbaa'uWebtetlness unpaiE as of Mongage / Contract u
Ma 1, wrtent year Oate of application '
� 5..�� �
ao�o-ao a
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� � 5, 000. �/
�d : � a-��-o9
LU _ � LU _
W Caunb A�Witlimr
M ZIP code)
,�
COUNTY
1 20
Is Ne appfman[ the sale
legal w��`'itade ovmef!
j�J Yes ❑ No
someone oNer than spouse, I�icate with whom
What TaAng D'atriC?
Caunry
20
Us ihe P�PertY in Vuestion: Mn�aMAssessed
�Real Properly � Mnually hssesse�d
( 0.loble Hortie (IC 61.7-
�� �
Has u,s dedwsm eeen rea, u$�d on v�v
mr an,e�n yran r4L(.
��� ies ❑ No
20 20
Date (manfh. daY. Y�� .
1! We certify under the penalty of perjury that the above arW foregoing infortnalion is W e and cortM and that ihe applipnt is a resident of IrWiana and
owner I wntracY buyer ot the afinemertlioned property on date application is filed.
Person autlrorisd Dy Cuty execuled Power
or try
�
person (number arM shee; ury, sfafe, an0 LP tode)
�Date (monfi. OaY. Y��
�a -30 �o
, N7G� -
Date (rtpnN, Oay, ysa�
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