HomeMy WebLinkAboutMortgage_Miley^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ _= FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn d3709 (R11 / FRJ)
�' ,�,� Prewibed by DepartmeM of Local GovemrtreN Fnaxe
�NSTRUCTIONS: ' e wpn
To 6e fifed in person or 6y mail wifh the CountyAuditor or Counry Recorder ol fhe county where the pmperty is located. �p� L U � �
Filirg Dates: 1) Real Pmperty: Must file dufig the year (or which the deduction is sought Counry Auditor
2J Mo6de / Manufadured Homes rrot assessed as Real Property Must file dunng the 1weNe (72) months .'J.
be%re Maich 31 0( each year the deduction is soughf. Re��
See reverse side for additional instrur.tions a� qualifications. G I BSON CO
App6eam (owrer mwNlaC b�- see re�s m reverse side) _., n .
Ta�urg
Asessed value ot real P�P�Y ��
Ma�Ch 1, anml ytlr
Ii m, what is his I trer ezaU share ot interest?
If �wne on n.md is QAterent Ihan Nat of app6cant, uNibte 6ebvr
�
w mntraU seAer (nwMer end stree4 cify,
Nanre W asvgnee or otha! ovmer or hdder oF morigage --
Atltlress of assg�ree (number arrd spee4 �rtl: sbte, aM Z/P cotle)
Does applicam wm propacy in afry oNer If yes. what munry
muniv in Ind�ana? .—. .—.
approued "u� Me amount of:
20 � 20
Sigfawre ot Camh Auenor
b
If awned wtth someane ottier than spouse,
numbu
�� u No
Is iM 7�PenY in Gunstio2 MnuaOy Assessed
❑ Real Pmperty ❑ ArmuaAyPsses�d
m�p�R uNa
1
i i- yya5
20_ � 20_
Counry
20
3�
�en reQUested m P�C�Y
�_
Date (rtanfh. OaY Y��
20 _
I I We certify u�er ihe penalry of perjury that the ahove arW foregdng infortnalion is We and cortect arM that the applinnt is a revdent of Intliana aM
owner I contract buyer of Ne aforementioned Droperty on date appliration is filed.
7nawre (oA9Prs /W rertre) �1 .�� ♦ / Data (rtn+rth� daY. lea�
Person autlrorrsed Oy
�
w Cy
persq� (numberaM sbea{ (ity, s!a[e, an0 ZIP mde)