HomeMy WebLinkAboutMortgage_Teeters"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ : FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 03709 (R11 / 6-09)
S Presaibetl by DepartmeM of Laol Govemmenl Fnance
INSTRUCTIONS:
70 6e filed in person or by mail wiN the CountyAUdito� or County Recnrder of the county where Ihe property is loca� G 3 F �nth.
Fd' Dates: 1) Real Pmperty: Must fi(e dun fhe �
mg ng }rearlor which !he derluction is sought County Auditor
2) Mo6i/e /Manufactured Homes not assessed as Real P�peRy Must file dunng the tweNe (12J months
6efoie March 37 of each year the deduUion is sought. � � Counry Recordu
a�See reverse side for additional instrucUons end qualifications.
Ap�pn(ownerof,�ntraftbuyer_searesvicnonsmrerersevee) � GIBS
o�s�a
d m�W poper;y as W
Y�
pl
oi mortgagea «mntraa se9er
Address of nartgages ar mntrar�
Name M assignee w oNa owner or hdder of rtwrtgage
gnee (number erM stree; tlry, stete.
wm property in any oNer
Deduction approreG in �he
�
�IL;
Remid iwmbel Page num0er
� t�
unpaitl a d Is Ihe eppEant Na sok
legal w eWitaHe amrYi
❑ Yes ❑ No
If ownetl wiM someone oNrl ihan spouse. indimte with whan
ee( �y, sbm. aM LP code)
Z/P coEB)
If yes, what muntY7 What Ta
' � � COUNTYAUDITC
20 _ 20 _
IS CC P�PeRY YI QYCStIM: MIpIBPJ AS52SSCd
�Q2� P(Op211y � i1IQ1112�hJ �SEd
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Dra���cr NO....���...1....
C:���d �O. ....:.?�`4.�.%.....
� il��e �yq o , �so -
nY
20 � 20 � 20 _
(rtaNh. tlaY. Y��
I/ We certHy under the penatry of perjury that the above and foregoing infomialion is we and correci and that Ne appivant is a resident of Indiana aM
avner I conhad buyer of the aforementioned properry on date application is filed.
� �h �u�) �/ Date (monM, eaY. Y��
s �'
N-!i/ t J.A
tlry state. anC ZIP oode)
autlror¢ed Gy dWy exewieC Pwer of Attamey or by IC
Oaie (rtmnfA. dai: lee�
lddress of auNmrzed peF.,an (numberard sbee4 �y, sble. an0 ZIP code) . I .
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