HomeMy WebLinkAboutMortgage_Riker"•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm a3709 (R71 / 6-W )
� P P�esoibed by Departrtertl a( ln�al GmiemrtreM Fuiance
i
INSTRUCTIONS: ppg�d
To be filed in person w by mail with the CountyAUditor or Counfy Rewrder of Ne tounty wheie the property is located. FJ [ 1' �� Z�� 9
Fil'mg Dates: i) Real Pmperty Must file dunrn� the }rear for which the deduclion is soughL � County Auditnr
2) Mobde / Manufadured Hortres rwt assessed as Real Property: Must file dunng the fweNe (12J monfhs �
betore March 31 of eacA yea� Ne deduclion is sought. `—�IJ?µ�� � ecord'
O�/
See reverse side (or addilunal instrucG'uns and quali�cafions. y
AppGfant (ownci or.F�baa buyer - sea {�SLklions m rC�R9 sifa) � . _ .- _ _ -
Tarim� District ) Key iwmGer / legal tlrsaipGrn J Record num Page�numbal
- 1 - - O� -C�� �(o -bo d� � �c6
A� rdlue of real pmpaty as of Mortga9e / ContraU Indebte0ness unpaid as ot Mortgage / Can� mEebtedness unpaid as o( Is Ne apprrcan[ Me sde
Ma�di 1. a�[ yrar A1amh 7, wrtem Y� Eate of aOP�� kgal a W�itaGle awnM
❑ No
II no, what is his I her axaU share ot interest7 If wmed wiN sortiearre other than spouse. Ndicate wBh whom
tt name m remd is Gilterent Nan that W aDP��t'oidirate Oebw. Is ihe P�GQrtY in Cuesiion: MrnwAy Asussed
� ProPertY ❑ MnuaDY�
Abdle Flome (IC 67.7=,
snee; r4y, stale. eM LP code)
assi�ee v othu owner or holder af rtqrtgage
AdC�ess ot assgnee (number arrl stree; r�ty, stela, and ZIP code)
epplitant v.m pfoperty in any other
ry in IrWiare?
❑ Yes
�crion approved in iha amount oE
2o zo
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_ _ ' _ ' _ _—_
What Ta�d(g Distrid � .
_ D��a„���- No...abo`� .......
COUNTYAUDROR
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,
Counry
aar. r�A
I I We certify under Ne penalty ot perjury that Ne above anG foregoing intortnatlon is We and cortect and that Ne appGnnt is a resideni of IrMiana and
owner I mntracl buyer of the aforemerrtioned property on date applicalion is fileA.
dry, state, and
Dy duty executetl Power
person (number anC sbaet, dry, stafe, an0 LP code)
O
Date (monM. daY.