HomeMy WebLinkAboutMortgage_Greene (3)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Year v
FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fotm C3709 (R71 / G09)
, 1 Presaibed by DeGartrtrerd ol Loral Gwemmenl Fuance
µ 'le Ma
INSTRUCTIONS: M
To 6e filed in person w by maii wiN the CountyAuditor or Counry Recolder o/ the county where the pioperty is located. F� �� �:
Filirg Dates: i) Real Properry: Must file dunng the year for which the deduction is sought ��� ��F�AUditnr
2) MobBe / Manufacturcd Homes not assessed as Real Properly Must file dunng the tweNe (12) months
befae MarcM1 31 o/each year the deduction is sought. � �d�
GIBSO C
See reverse siUe for additbnal instructions and qualifrcafions.
nppGwnt(ownerww�ntacrbuyer-seereshir�wismrererseside) �
Ta�Qrg DistriU . Key rw
AssessM raAre dmvl pfopMy es o(
Ma�d� 1. ar�sY yr.dr
' 110. Wtld� 6 �16 � h2f BIfZG S�1Bf8 Oi V1iPRSl�
�9a9e / Canbau 4de6tedrress unpaiC as U
hwm 1. anrem yrar
`il bbh
Ii owned
on rem�d is tlilterent ihan t�at W appOmnt'u�dinte beb�r.
«mnaaq
A�tESSOt rt�oR9aoPP or.rml� mon. �.u..�w ann emwr_ �w. er�re
r�m��
� �TaN, �a� 0
,�e�o�� a011- I (n�1
Oces applimm �
munry in IMian
NTat Tabrg DisVHY?
RecorO number � Pape number
cWebtedness unpaiE as of
y.^r''
perty in QuesUm: Mnuelly Assessi.-0
Hoperly QMnualyAssessed
Mobiie Fiome (IC 6
Has tha tletlurtion Oeen reVUesreA m
fw wfrent year?
❑ Yes
No
COUNTYAUDROR
DetluGion app(oveE in Ux amount aE
20 20 _ 20 _ 20 _ 20 20 20
Sigiuwre ot Camry nudiwr Caunry oate (mmte, eay. Yea�
I/ We ceNfy under Ne penalry of perjury that the above and toregoing infortnaGOn is We and cortect arW Nat the applirant is a resident of Indiana and
owner I mntrad buyer of the a(orementi ed property on date applira0on is filed.
SlgnaNre � n fiN name) Date (monih. daY. Yva�
F rrsitleni aEtlr¢ss of appGmm (num �and sbce4 �Y. ��e, antl LP ootle)
� %���/P C.�
Pe�son autM�¢eA by O�Ay executed Power dHilomeY � M IC bt.t-t2-0.7 Date (monM. tlay, yea�
Pddress of auUmraed person (numOer aM stree; dry, state, aM LP mde) _