HomeMy WebLinkAboutMortgage_Broshears (5)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm d3709 (R71 / 6-09)
, l Presoihed by Department of Loml Govemment France
INSTRUCTIONS:
To 6e �led in person w by mail wifh the CountyAUddor or Counry Recnrder of the wunry where the property is located. J F���'���Q � Q
FiNrg Dates: 1 J Real PmpeRy: Musf file dunng the year /or which the tleduc6on is soughL County Auditor
2) Mo6ife /Manufadured Nortres rrot assessed as Real Property: Musf file during fhe fweHe (12J months
6efore March 31 o/each yearthe deduction is sought � ❑ nty Remrdu
See reverse side for addi[ional instruct+ons arM qualific�ions.
AoMxaln'lamerorcon7racL6oRr-seeresbt.�umrererse ' ) GTBS'UN
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/herexad
tl tume m remrd s QRumt than thai W app�n; inEUate bebw.
Name of rtiortga9ee d
naaress or ��
�
�c �m: ��.
(number anC slree4 �; s�ete. antl ZIP catlaJ
Dces eppircam rnm pmpMy in any oNer I If yes, what munt/1
munly in Ind'gna?
❑ Yes ❑ No
DeEuclion app�oued in the amoun
20 _ 20
SignaNre N Counb AW imr
20
az
Ifowned
'CYJ o2 � '% P�e�(o % G
�
ortgage / CmVact intlebtedness unpaiC as of Is Ne apd�� Ne sde
3ce of aDP��� le9al w eWitatle ovmeYl
❑ Yes ❑ No
th someone Wher Ihan spouse, hdircste wBh whom
)�s jth..e. �p�ro�perty in Quesaon: MnuaOy Assctsed
ICw�' RoPerry ❑ ArmuallY AssesSed
MoWle Fiome QC 51.1-i
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; ,� �9g �P�
_ C8t"(] \� . ..................... �
20 _ � 20 _ � 20 _ � 20 _
Y��
I I We certify under the penalry of perjury that Ne above and foregoing infortnatlon is We and corted aM that the applirant is a resident of Indiana and
owner I contract 6uyer of the aforementioned property on date application is filed.
SlgnaDUe (owner's hN iame) . Date (rtmfh. daY. 3^��
X�a..:r� �ra
FWI rcsitlent atldres o( appGrant (number entl street ml: sfafe, and ZfP oode)
K �J\\ ��st �Ci:- `���' ��L�a�/�a C..l} .a_til `-k-ll9��
Pr�son autho�aed Cy tluty ezecuted Power of Anm�eY a M IC bi.1-12-0.7 Date (monN. dey, yean
Pdtlress of aulhoraeA person (num6er aiM sbeet, dry, sfate, and