HomeMy WebLinkAboutMortgage_Stafford"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun hip Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn a3709 (R71 / 6-09)
S % P2saibeE by �eP��ra at Laml Govemment F�nce
� Fle Mark
�srRUCnoNS: G�
b be filed in person a by mail with !he CounryAUditor or Counry Recorder of the counry where [he property is located. ���� ��
Filing Dates: i) Real Properry: Musf frle during the year for whiHr fhe deduUion is soughL M y��yr
2) Mobde / Manufactured Homes not assessed as Real Property: Must h7e dunrg the nvelve (f 2) monNs
6efore March 31 of each year tAe deduclion is swght. ❑ ���W �e+
See reverse side lor additional instmaj6�s aiM qual�ficafbns.
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II iro. what {s his / her exa
If name m record is difiei
Name ot rtwrtgagee or a
nnaRSS ur nan9agee a
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couNy in InEVna?
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a of Mortgage / Contrac[ indebtetlness unpai0 as of Mongage I Contrac[ vWebiedness unpaid as d Is Me appl�nt Na
Martl� 1, a�rtenl year date of appGntian legai or equitade oxne(.�
�� ❑ Yes ❑ No
are of interest? 1/ owne0 wiM someone dher Ihan spouse, iMicate wiM whan
--.. ."'"'•^ �`°�,�+�' Is Cre P�GertY in Cuesaon: MnueOy AsseSSeE
RealProPertY ❑lvmually0.sses�
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abog-a�5y
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Flas Nis deCuUini been repunstetl m praperty
For wrtent yeaR ❑ Y�
❑ No
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1 nry Date (monN, tlay, year)
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�') �'� �� ���/1 .ve and faegoing infortnalion is true and mrtect and iha[ ihe applitznt is a resident of IrWiana aM
�;� y on date application is filed.
°_' ' __ ' """' """ _" _ � Date(rroYh.day.Y��7
F�A reSiEent adtlress W appliran[ (nurtPoer antl sbcet. rity,
MCress of authorrze0 persan (num6er arnd strceC a`b. stale, and ZIP cnde)
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