HomeMy WebLinkAboutMortgage_Sims°'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ POR DEDUCTION FROM ASSESSED VALUATION
• State Fwm C3709 (R71 / 6O9)
� f PrgaiEeE by DeG��rtl af Lod Govemmera Firiance
�w '
INSTRUCTIONS: �
To 6e filed in F
person a by mail wifh the CounryAUditor or Counry Recorder of the counry wl�ere the p�operty is located. — Z 0 ��
Fifing Dates: 1) Real Property: Musf file dunrg the }rear for which the deduction is soughG .� Counry Auditor
2) Mob�7e / Manulactu2d Homes not assessed as Real Property: Must file dunng the AveAre (12) months
6e(ae March 37 0/ each year [he deduction is sought. ���ef
See reversa side Ia adtlitionel inshucWns and qualifications.
MP�a�f ( r � cont2ct buYer - sCa �y+K'lN45 m reverse side) /a . . . _ - _ . . . . . .. . . _ .
lG�� (O — / J— (J—G
Y�popertyasd ge/Cantraau
year 1, artent year
tt no. �Mat Ls 1�5I Irel e�G SWrB ot 41fEt¢s[!
tlnane m remrE's d�leren� Wn tAa1 W a0G��4 tr�tlirate Eelmr.
�
Nama of rtnrtgagee or mnaaU se4er n �A
, ///l.i_
Atldren of rt�omja9ee ar mntract se�er (nun6ei and sCeet u�: 5a�,
Nama M assignee or oCxr ovmer w hoMer of morigage
Ooes ePd�nt own property in e'ry oNer
cwnry m �naiana?
❑ Yes
oeeucba, avyweE in the
qry. sfale. erM Z/P catle)
If yes. what muntyl
❑ No
�J
H a�metl wit� smneone aher
Hess unPaiE aa of LS Ne ePP�t tlx sde
� kyal a ew��de owne/1
❑ Yes ❑ No
ise. "via'rate with xtrom
�C �fOp!!{Y ifl CYESSiOl1: Mf111911YAS5CS5Cd
Real Roperty ❑ Nmua�y Pssessed
_ . �j_Q`}1......•• _
.�- " "�i• \O...s.r.
D'�a � ' a39 � . —
WhatT. . ` � nY
...� � No
_ C�l�j�0• •.�•9p��.�'
�uorroF O � �J • —
2pr1�/j 20 _ 2Q 20 <� _ 20 _ 20 _
I C/ I' �,L
�uae CamN Auditcr Counry Date (mmth. eav. Y�d
I I We certify undu the penalry of perjury that the above and foregdng intormalion is We and cortect ar�d Nat the applinnt is a resideM of Ind�ana a�
er I contraU buyer of the afaementioned property on date application is filed.
� aq (owrrerS hAname) � Date (rtwRh. daY. Y�)
� FW eOCrt
Pr�sm aWromed
ce�
ary, state.
riey m by IC 61.1-12-0J
ciry, sfate, and ZIP code)
LQ . �""' — L G b —L / ."' ' '