HomeMy WebLinkAboutMortgage_Mason (8)'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun nshi vear
�_ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sta[e Fortn G3709 (R71 / 6-09)
�' PresaiGed 6y OePartmeM of Local Govemment Friance
�wsTRUCnoNS: �'P,(��` Z0�2
To be filed in person w by mail with the CounfyAUtlitor or Counry Recortler o! the county where fhe property is located. F� �� ��
F�1mg Dates: i) Real Pmperty: Must fde durng Ne year for which fhe deduction is sought.
2) Mobde / Manufac2red Homes not assessed as Real Property: Must h7e dunng fhe hvelve (72) monNs ��u V
6efae March 31 ot each year the deduction is swght GI 50���� ��R
See 2verse side Ior addifional instructions a� qualifications.
rqm�traabuyer-seere ' mrenerseside) •
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Ta Di 'a Key n�m0er / legal des ption Retortl numbpl Page numbu
�a� - 3 i - �o-oao.49-ao� � //9�
Aseaed vaqc d rnal property as W Mortgage / Contraa iMeEtedness unPaitl as d Morigage I Contraa mEehtetlness un7� a d Is Ihe ePq�t the sde
Mardi i. arrent year Mamh 1. wrtent Y� Eate o( aGP��n/J y o d le9al or eWYable rnmeR
%7 JQ�%" ❑ Yes ❑ No
if no. what a ha / her exarl
�f name on reCOrd 6 difterent lhan tha� of apP��l �dicate bebw.
Name W rtartgagee or oontrarl seller �
Add�¢ss d mortgagee or cantract seDer (num
Name of assignee or oNer owner or hdder ol
Md�ess of assgnea (numberaM stree4 Gry,
Oces appfiUnt own property in any olher
wunry in Intliana? ❑ Yes �
Deduaon aowweA ui ttie artaunt of:
20 I 20
I/ We certify urWer ihe penatty of
owner I conVad buyer of ihe afor
�i� ' n wre (owners hNname)
� �
Fullresidentad ofappfeant (num0e
/� ��w _ n C
dtly ezHVteO
sfale. aM ZIP code)
� V—i S u � l
�—��-5 ct.�
� ��� ��-
��7 ci, 3c�v `'—'
saneane aher ihan spouse. iMiqte wM whan
�
\
�
CA�,�j s� ��
Mdress of aWiu¢ed person (num0er a�M suee4 dry. sbte, aM LP cotle)
�Is N properry in Qurstion: MnueM A,sessed
ea� afoaertr ❑ nrmua�yPSSessed
�C Mobile Fbme (IC G7.1-7)
}�L �� /� =a- 9
,3, 3a A�-
Mas Ihis deEUdwn Oeen repuesteE m ptapeity
r� a�n y�n
❑ ves ❑ No
20 20
�,,�,.�y�a�
at t�e applirant is a resident of IrWiana and
Date (month, day, ysa�
oa� ��rn, ear. r�n