HomeMy WebLinkAboutMortgage_Wiper Corporation'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T shi vear
_. FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn C3709 (R71 / 6-09)
� w. Presaibetl M DeGa�M of local GovemmeM Fuiance
File Mark
wsraucnoNS:
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To 6e ned in person a by mad with the CounryAuditw or Counry Recorder o/ the counry where the poperty is located.
Fifhg Dates: 1) Real Property: Must file dufirg Ne year (or whicA fhe derluction is sought. Counry Auditor
2) Mo6ile / ManuFactured Homes rrot assessed as Real PropeRy: Must f+le d�n� the fweNe (72) months
6efora Maich 37 0( eacA yaar the deducUon is saght. e�
See reverse side 7or edditional insWCtbns arM qualficaUons. G IB n
A�f�(owreiaroo(rtlaCbuyar-see onreverse �) _ � • � !/ � _ ' ' _ •'
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tt ro, what Ls his / hu exarl shara of interest7
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Mard� t ew_remtract indebtetlness unGaid as o7 Mortg� Pl�� iMe6tedness
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u cantrad se0u (nwnbal end
or hdder af mortga9e
AECreu of assynea (num0ar arW srtce4 �: stele, end
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Yes LI No
Is ihe property in QuesUOn: MnuaM AtsesseE
] Real PfoPenY ❑ Nmuall�' Ass�sed
Mobile Fbrt�e (IC 6
Has N'a deductim Ecen requested m property
rw a�,�n yPan n.,_ _ r-i
20 � 20
I/ We cerGry under Ne penatty of perjury that _..wve arW foregoing infwmation is true and cortecl arW Nat Me applirant is a resident of Indiara antl
r/ contraq buyer ot the afae �rtioned property on date application is filed.
�� i `Z'C2i�� �'4�C!/ !ti � oa� ��,a,m, aar, rean
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7 ent aEdress W appfimnt (num6ere stree4 mY, ��e, artl LP aotla)
ps¢cut¢tl Power o(Fttmiey or Cy IC 61.1-12-0.7
PdtlRSS of autha'ved persan
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