HomeMy WebLinkAboutMortgage_Morton'+ 5TATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C -; , To "Ti'7i ear
; FOR DEDUCTION FROM ASSESSED VALUATION A e
State Fwm 03709 (R77 / 6-09) ' � �
� w. P2srnbed by Departmerd W Laral Go�.emmeN Firerce
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wsrnucnoNS: I�i1v i�
To be filed in person or by mail with the CountyAuditor or Counry Recorder o/ Ne county where the property is located. F� �� ��
Fifing Dates: 1J Real Pioperty: Must file durirg Na year /or which Ne deduction is sought. - ,Qo(�b q�di��
2) Mo6Ae / Manulactured Homes not assessed as Real P ng ( J �� "' ""
�operty: Must file dun the twelve 72 months �/r �
6etore March 37 0/ each year Ne deduc0on is suyht. � UNT Y A��
See reverse side (oradditional insvuctbns arM qualifications. - GIBS
Key rnunEer / legal drsa'rybon
�� M. W�1816 �16 /:IP.f P�[2CI 5�1219 Oi YI:CfP3l7
tt name m �emd'a Giferart Nan tliai of apphan4 mC'vate 6elaw.
r�ame m �rtvasee
P4Ureu d mort9a9ce or mntraG seAer (nunDer antl sLeeG �: 5ate. aM �
Name of assignee w Mha owner or hdder af rtqrtgage
ACCress of assynee (number aM s1ree4 �1: sfete. antl LP catle)
Does aPP�� o•m woD�Y in any omer Ir yes, what munty.�
w
munty in Ind"ana?
, ❑ Yes ❑ No
as
What Taring D'str'r1?
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Reco�d num6er Page �wmbrJ
D/U a p�
unPaitl as d Is Ihe eGW�t Ne x
Ye5 LJ No
spouse, vMrcate wm wtrom
Is tlte WoPe+�Y in Ouestion: MnuaQy Assessed
❑ Real ProPertY ❑ M!walh'. A�e�ed
Mas ihis deduairn Deen re9uesteE m propelty
fw aurent v��' r-i .. r-�
20 20 _ 20 _ 20 20 20 _ 20 _
Inature W Camb Auditcr Counry Da�e (month. daY, Y��
I/ We certify under the penatty of perjury that Ne above arW foregoing infortnation is We and mrre<1 ard that the appli�ant is a resideni of I�iana aM
awner / mntract buyer oF the aforementioned Property on date appliration is filed.
�EUe (oxrrel5 N�qe) Date (nimfi. daY. 38�A
Pgson auU�C Dy dWy rsecuted Porer olAt(orney w by IC 61.1-12-0.7
AdOress of autha'ved person (number arM sbue; ciy, state, an0 ZIP code)