HomeMy WebLinkAboutMortgage_Meny (11)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ship Year
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� FOR DEDUCTION FROM ASSESSED VALUATION '
�� State Form 63709 (R11 / 6-09)
♦ � Presvibed by DeV��rd o1 Loml Govemment Fi�anca
File Mark
wsrRUCnoNS: JAN 9
To 6e filed in person of by mai! wiM the CountyAuditw or Counry RecoNer o/ the counry where the pmperty is located. ����
Filirg Dates: 7) Real Properry: Must fite dunrg Ne year (or which !he deductlon is sought C_�. Counry Auddnr
2) Mobde / Manu(aUUied Homes rqt assessed as Real Property Musf Re dunrg tAe twelve (12) rtwnths
befae March 37 of each year the deduction is sought � Counry Recorder
See reverse side !or additiona/ ins�mctions and qualifications GI BSON C OU N
IAppGrant(owncrarar2�zabuyar- mrevrrsesitle) ' '
Assessed rdNe d real property as N • Rbrtga�
IMart�h 1. amenl ye.ar MamJ� 1y�/
1�
I( m, what k Itis I Irer ezar2 share of interesi?
If name m �ecprC rs Eirterent Ihan Inat of aOP���• �diwte beb�
Name or rtrmgagee or mntrart seue�
Pddress W mortgagce w mntrad se�er (numbe� and stree4 �:
Name o( assignea w other owner or hdder ot mortgage
Aildress oi assiqnee (number aM stme( ary, state, and Z1P cnd�
Ooes applimnt ow*i property in any �
counry in IMiana?
❑ Yes
Deductlon apprweC in ihe amount of:
20
Sig�aMe of Coimb Aud'aor
CP1
az
Remrtl number
t
a cWebteMess �spaitl as of I
.. _______- __ .._._._..._._._..._No
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a o I I ,_;
ZlPCOda) 1 ( / V —
v� L _
T � � 3, y 1��. � _
COUNTYAUDRC
20 � 20 � 20 _
Caunry
I/ We certify u�er the penalry of perjury ihat Ne above and foregoing infortnation is
owner I mnVad buyer of ihe aforemenUOned property on date appiiration is filed.
andLPaodel_ .
esecutetl Power W Atlomey w �y IG 61.1-12-0.7
PdCress of authw¢etl person (num0era�M stree4 �Y. sfa(e. arM ZIP m0e)
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