HomeMy WebLinkAboutMortgage_Bise^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co o Year
,__ FOR DEDUCTION FROM ASSESSED VALUATION
� State FOtm G3709 (R71 / 6W)
� Pre5ai0ed by Department of Laml Cmvemment Fumnce
�w File ark
�vsrRUCnoNS:
�ro 6e (ietl in erson of b mail with fhe Coun Auditor or Coun Recorder o7 Ne coun where fhe ro ��
P Y �Y b N P PeNY is bcated.
Filhg Dates: 1) Real Pmpetly Must file during Na year /or whirh fhe deducfion is sought. .�. q�d���
2) Mobde / ManufaUUred Homes rwt assessed as Real Property Must fi7e during the twelve (12) rtanths
befiue March 31 of each year the deduclion is soughf. ❑ ��b�
See reverse side Ior addiLOnal inshucUons arxl qualifitatbns. G I BSO
AppGcant(o ror r-s side)
T' // Key �wwmber / kyal Eesaiplion RemrE ramber P e
�� - -� -ad 1.096 � �
Asased vAue dmal p'operty as ol Mortpape / Contrarl "ude6tetlnPSS unpaid as of Mortgage / Cantrad'uWebteMess �mpaitl az of b Ne ePDfrant Uie sde
� 1, m�ent Year Mard� 1. � M"1 �� tlate of aOP��^ �I n YPSe �� NO
tl ro.
u
W rtprt�agee a mntrarl se0er
Address of rtnrt9agee a contrad se0er
name m assgnee w
7er aM streef, ciry, state. a� ZIP cade)
mortgage
slafe, and ZIP catle)
applirrm wm property in any oNer
Y �� iwg�?
❑ Yes No
ctirn approveE u� amouni of.
20_ 20_
signature ot cwnN auaiwr
spouse.
45 Me WoPertY in GuesUan: MnUaP/ Asse55etl
❑ Real ProPertY_❑ ��Y�
r�o� r� nc s
,•: �"" � �{ I� .
Dr.a�i�er..NO:.......... c.......
n yes. wnat muntyt
Card NO•
COUNTY �S7'lj�
/�7�
20 � 20 _ � 20
y'7y0........
.....� �9! �y.°°
�
n prapvty
2[1
I I We certify unAer Ne penalry of pe�ury that the above arW foregoing infomiation is We and correct a� Nat the applirant is a resident of IrWiana and
owner I mntracl 6uyer of Ne aforementioned pmperty on date applicatbn is filed.
piature (4wners /u0 name) .. n !1 Data (rmrcA. daY. Yea�
c��*.^
state,
per5on (number aM Sbee4 rity. stafi. antl ZIP mUe)
Oate (monfh. daY iee�)