HomeMy WebLinkAboutMortgage_Corn� STATEMENT OF MORTGAGE OR CONTRA T IN�E� �E S Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALU'ATION �
Stata Fortn A3709 (R71 / 6-09)
� P,rsa;0e, by De�r�erk a(,.�, Gove,nmerrt Fina,xe A U G 5 z u� u
File Mark
INSTRUCTIONS: �,�y/�� /v
To 6e filed in person w by mail with the CounryAuditor or Counry Recorder o/ the coaniywrtpe'm�Eyfl-4Aerty is located. F�� �
FiNng Dates: 1) Real Property: Musf file durirg the }rear (or which fhe deduc�Q�o�p ¢ h<� �l County Auditnr
2) Mo6ile / ManufacNred Homes rrot assessed as Real Propeltj!��i��e �d��T(.�Pj months
6efore March 37 0! each year the deducfion is sought. ❑ CouMy Recorder
See reverse siCe for add'Rional inshuctions antl qualilcations.
Appfpayl(ow�rer a wnUaC Duyer- see raS�i�vgQn reverse side) �
' DisVat Key num6er / kgal Oesaiption
-� _ $-�1
A�essed raWe d P�P age / Contrai
Marrh 1. nr�errt 1 artmt yi
a ;5 00
u�. �� n� � n� �uu snara a�re�n
ir narre «i rema m c�c mao mat m app&ani, m
������� �
0
ACdress d rtnr�a9ee or cantrad se9er (numbe� am
Narne d assi�ee w
anaress
mer w halEer of mort[J:
� aM saee4 NY, s�te. •
in any othel
� Yes ❑ No
oeduc6m appm+ad m are amaum
�_ � p_
$igM' �PB d C.OWIIy AIIdROf
- o00 . 23 �F -aa
aPP��
N wmed with someona other ihan spouu,
I wmhar Pege number
)05 O
as d Is Me eppaant Me sob
legal or epuitada o�vne(t
❑ Yes ❑ No
with whom
���U, �►rOS1J��
0�p ,v��-�o�n� 9�asc�o�
a�� -�- 53 �°
CouMy
vew lnv . wn ��^-�
1 I We certHy under Ne penalty of perµiry that the above and foregoing intortnation is we and cortect aM ihat the appGrant is a residmt of IMiana aM
owner I contracl buyer of the afaemeMioned property on date apd�ation is filed.
y�pnue (ownefs f� name) Date (rta�. daY• Y8a/) �
/ : %� -f---. iF _ . -
�
daWbrtreA pvsa�
. sble. aM LP mtle)
Z-a.dY\
by IC 61.142-07
34, d/Id LP tt1tl8)
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