HomeMy WebLinkAboutMortgage_Hoover"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C n Tow hi ear
._ � FOR DEDUCTION FROM ASSESSED VALUATION
- • Sfate Form d3709 (R77 / 6O9)
�' ,«. P2saibed Ey DepartmeM af Lo�l GovemmeM France
�NSrRUCnoNS:
AUL�''3"'�`'�009
To 6e filed in person or by mail with the CountyAuditor or Counry Recwder o/ Ne counry where the property is bcated. Form med wim:
F7ing Dafes: 1 J Real Properry: Must (de during fhe year for which the deduction is soughL q�di�
2) MobBe / Manufactured Homes rwt assessed as Real Property Musf file dunng the IweNe (72) monfhs 6� �
6etore March 37 o7each yearthe deduction is sayht.
GIBSO C u T �er
See reverse side foradditional insfructions and qualifications.
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Key rwmber / legal desaiDtion
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XreaIVW asof Mor(qxge/ContraaintlebtednessunGaid:
ye2r Martl� 1. �airt/ent Y�/ +1:,
�.S /� ��J n Q
Name ot mortgagee or mntract seAer �/l��
S. � .
nedress ot morcqaqee «cmaaa seoer (n rd sfreet �l: sfate. aM LP code)
Name of assignee w ahr! owner or hdder of mM�age
ADtlress of assignee (nurti0er aM street mY. sta:e.
Dce. epplinnt ovm property in eny oNer
munry in InEana?
❑ Yes ❑ No
Da7ucGn� app�aved N tlre amouN of.
20 _ 20 _
sigranne d Camb Aueiwr
i I We cer[ify uMer�e penaly of
owner I contraa buyer of the afon
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Person auNO�aed by Outy ezewte0 Power ol Attomey
yes, wnat county.�
2tl_ � 20
Reto(d number Pa9e number
- o0 7 2-00?
Convu2 irMehteMess unpaid as d Is ihe eppli�ant Me sole
fmation Iegal or equitade oxnef.�
❑ Yes ❑ No
x ot}wJ tl�an spouse, Ndiwte witli whom
Is IM property in Questim: Mnually Asscssed
� Real Property ❑ Mnually Asse,ssed .
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above and foregning in(ortnatlon is We and correU aIM that the applicant is a resident of Indiana arM
�erty on date appli�atlon is filed. -
state, and ZIP mde)
� � �
person (number antl sheet riry. sfate, and LP cotle)
Date (mmlh. tlaY• Y��