HomeMy WebLinkAboutMortgage_Cope'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_. , FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn d3709 (R71 / 6-09)
, �«. � Presaibed hY DepaNnenl 01 Lacal Gwemmanl Firence �
ie a
INSTRUCT70NS: ,,,y -
To be �ied in person or by mad with the County Auditor or Counry Recorder of Ne county where the property is located. �-1
Filirx� Dates: 7J Real Property Must file dumg the year (or which the deduclion is soughL � County Audimr
2) Mo6de /ManuFactured Homes not assessed as Real Property Musf file dunng Me twelve (72) months
before March 31 of eacA yEar the deduction is sought. � ��
See reverse side /or addiWnaf insLuctians arM quelifica6ons. ,,,es„u i.ni wrv ei imtnw
I rWue aF real P�D�Y �
nx�aa year
no.
legel EeufiGtion
� _��_�, _
that o1 app4an4 h�G'uafe Eebrc
Nanre a rtnrtgagee or mnuae sWer
�
AOd of rt�mt�jages or mntrad se0
Name m assi9nee w ahu owner w r
yoperty in any oNa
❑ Yes
Deductian sCW� in Ne amouM
O � IPapenumba
-b� . 3g9 30
unpaid as ot Mongaga I ConSaa inOe6teMess �mpaid as d Is iha eppAOnt tM st
date of appOCation legal or eputtade oxr
smm, aid LP code)
spouse. uidxate wiN M1wm '
IS UIC pfOpCll`� 111 QtIC$OOfI: Mf W8%' AS5255Cd
�� �x�r ❑ ni?uwN nssessed
mortgaga �/�
l�1V ..
stete.andLPCOdeI lll':1�\'CC 1�•. • "" •..•••.
If yes. whal touni�/7 Nlhal Ta�dnB D'c v — � ` • • • • • • •
. �
i�lo Cat'C� � . •�•�;�.
No
20 20 20 20 2q _ 20 _ 20 _
Signawre ot Counry Ntlitor Counry Date (/mNh, daY. Y�A
I 1 We certfy under the penatty ol perjury that the above and foregoing intortnation is true and correcl arW that Me appGrant is a resident of IrMiana aM
owner I mntrat] buyer of the a(cuementloned property an date appliration Ls filed.
7
pe�son (numOeraN sbae4 dry, sta�e, en0