HomeMy WebLinkAboutMortgage_Bajzath"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ . FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn C3709 (R17 / 6-09)
S � Presa�betl q' OeGartmeM af Lnml GovemmeN Fuance
w.
wsrRUCnoNS:
To be filed in person w by mail with the CountyAuditor or County Recorder o/ fhe counry whe2 the property is IoCate�PR F� ���
Filirg Dates: 7) Real Property: Must file during the year for which the deduction is soughL � County Auditor
2J Mo6de / Manuladured Homes rrot assessed as Real Property. Musf fiie dunng Me iweNe (12J montf�e �
be(ore March 31 o/each year Ne deducfion is soughL County Recordes
See ieverse side for additional instructions end qualifications.
MP��� �eraj{w�lraC buyer- see�strcfnr+s m myqrse(sdgYJ .
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ed�Wt�edmW RW�Y�a
1, anrsrt yrar
no, what
nartie m
� � �' v O' �/. � _
Mortgage / ConbaG "vdebteE�s unPaid as o( Mortgage / �
Mart�h 1 a�rmnt yrar date ot appl
Jame of rtrcxcga9ea m m�tred sWer _/� —. i�� –
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� N�J I��P I VF
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d�"�� ���rl
0
approved'v� ihe amount of:
! state, ard ZfP ca�/
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.,
at munyt
COUNTY
Remd number Page
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impaid as M Is ihe eppGn
Yes LJ No
h praperry in Questim: MnuaDy Assessed
Real RoPeKY ❑ A"^�Y �
a - a - 9 •7�A�
NTat Ta�dfg Distrid?
20 � 20 _ � 20 � 20
N's CeduUion Eeen requesteE an propvty
��rem YeaR r-� . _ r-�
"Pa���Dl
�Wre d Caunb ��� I Counry I Oate (montn. tleY. Y��
I/ We certify under ihe penalry of perjury that ihe above arM foregoing mfortnalion is W e and correct arW Nat the applinnl is a resident of IrMiana antl
owner l contract buyer of the aforementioned qoperty on date application is filed.
��la�xiefs fiAI name) _ Date (rtmN. daY.1'��
7/ /� /i
D t= h`� S�u ri� dC�T Ti�d �f7C� a
Pasan auUnReE Ey dWy esewteG Power o( Att«neY a M IC F7.7-12-0.7 Date (rtnnN. daY, Yee�
Address of auNw'¢ed person (number aM street, dry, sfate, an0 ZIP cade) . ' _ '" _ _ '
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