HomeMy WebLinkAboutMortgage_Zollars^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
FOR DEDUCTION FROM ASSESSED VALUATION �
� State Fortn C3709 (R71 / 609) �
S,�„ � Presaibetl by Department af LocW Govemment Frence \�
� File Mark
�1STRUCTIONS:
To be fiied in rson w b mail wiN !he Coun Audito� or Coun Recnrder of the ooun where the Fwm med with:
Pe Y N N iY P�PertYislocated.
Fifig Dates: 7) Real Property: Must fi)e dunrg the year lor which the deduction is sought. � County Auditor
2) Mo6Ae / Manulactumd Homes not assessed as Real Property: Must file during the hveHe (12) rtronMs
6efore March 31 of each year the deducfion is sought. ❑ County Recwder
See reverse side for adtlifional instruUions and qualifications.
App5cant(erq�erwm�Uadbuyer-�ee�esfric�nsmrevers�'SSie) _ _
T' Distrid Key nunber / le9al
-e
A�srssed raAc oF real p�tY e N Mo�q a�.
R1arth 1. arrent year Marrh �
If ro. what ts Itis ! her e>aU share o( interesi?
aU
If rerre m �emd a 6fterent Nan ihat o( aPpGCanf, mGira
Name of mort�jagee or mntract seqer ��%. n
Pddress of nnrcga9ce or mntracl se0er (nwNer eM sbe
Name o( assgnee or oNer owner or hdder of �mrtgage
PdCress ol assignee (num0er and street �1: s+ate. and e
Dces applinn[ own properry in any other tl
munly in IMiana?
❑ Yes ❑ No
Dr�uc6rn aodoved in the amount oE
20 � 20 � 20
-� o � oo �
�ntraa IMebtedness unpaid as of
cdy, siala. aM
U
/ Conbact inEeMedness unpaid as d U Ne applirant Ne sWe
plication legal a equRaWe oxnel/
❑ Yes ❑ No
tt owntd wi� saneone other ihan spouse, IMipte with wlrom
COUNTVAUUROR
20 _ 20 _
Cour4y
Is tlie p�ope`ty in qurstion: Mnualty Assesud
�� ProPeRY ❑ Mnually ASSESSCd
bloble Hame f IC 61.1
Has Ihis deductim Deen re0uestetl rn P�Y
tor wrtent yeaR � Yes ❑ No
�
Daie (n�orrth. daY• Y��
20
1/ We certify under Ihe penalty of perjury Ihat Ne above and foregoing infortnatlon is We and oortect ar�d that ihe applirant is a resident of Indiana arM
owner I mntract buyer of the aforementioned pmperty on date appiication is filed.
(�soireAOwn¢fs hN rerye) ,/ i A_ Date (mm�M, deY. yae�
riry, sfare, and LPaotle)
auNOraed Gy Etdy ezeWted Power of AttnneY or by IC 61.7-12-0.7
MErnss of author¢e0 person (numDer ami sbaeL �: sbte,