HomeMy WebLinkAboutMortgage_Cross (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun hi Year
:�_-
FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Fortn 03709 (R71 / 609)
�' 1 PresaibeC by DepartrtcM of Lttal Govemment Fronce
'I Mark
�iSTRUCTIONS: F� � �_
To be (Jed in person or 6y mail wiM the CountyAudifor or Counry Recorder of the county where the property is located.
Fil"mg Dates: 7) Real Property Must file during the year for whirh the deduction is sought �. ��
2) Mobile /Manulactured Homes not assessed as Real Pmperty: Must file dunng the M�elve (72) months
belore March 37 o(each yearthe deduclion is sougAt ❑ Cou er
GIB
See reverse side for additional instructlons arM qua/ficataons.
AppGUyft'(ox+rero�cmtrpytbuyer-se�esnictiy�nsfnrereijce�side) �
��,�� ���� 3- o/- o oD. 9G 3- G�
h1wU�age / Contraa irde6ted�ress unpaid az W Mongage / Contr�act
Mam3� 7, artent yeer datc o( appficd�'ar�
/ her exafl share af inte25t?
It narre m remd a Eifie2nt lhan lhat of aDP��4
Name of rtwrtgagee s contract
mortgagce n
w other owner or hdder of mntgage
ot assynee (number aM streeG ury, sfate.
po¢s sPpMant ovm property in any oNer
tounryinlnd"ana? n .,"_
amount af.
20 I 20
mmeone
�4 ciN. state, aM ZIP code)
ZIP e) .
If 7RS. wh countyt NTat Ta�dng D'aGicl7
COUNTYAUUROR
20 20 _ 20 _
numbel
azd
ritable avmM
Yes ❑ No
� me wocem � o�esnm: a,�u,anr wzsess�a
�RealPmPertY ❑lvmuallyASS�d
N's deduClia� Deen
unent YraR
�
WW�Y
❑ No
20
Sig�uMe of Camb Auditw Caunry Date (monfh. daY• Y��
1/ We certify undu the penalry of perjury that the above and (oregoing informalion is W e and mrtect arid Nat Ue applinnt is a resident o( I�iana antl
owner I contracl buyer ot the aforemerttioned property on date appficatlon is filed.
� Sigre IuH ) _ Date (mordh, daY. YBa�)
S I � Z-o iZ
Fu �tlent address ol ap (number and sneet, rif}; state, and ZIP code)
�i�z S. wh;5��� N,�IS �2�. ����e �; ��� ��c�c�t�
Person autho�¢ed by dWy executeE Power of Attorney or by IC Gi.1-12-0.7 �� (�W. �Y• Yza�)
AAdressafauNaraedpe�sa� (num6eiaMSbee4dry.slate,anOZlPOOde)