HomeMy WebLinkAboutMortgage_Terwiske"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ • FOR DEDUCTION FROM ASSESSED VALUATION
. ' • State Fwm d3709 (R71 / 6-09)
� Presaibe0 M�M of Local Govemmerd Fuance
wsrnucnoNS:
To be filed in person w by mail wiN the CountyAuditw or Counry Recorder o/ the oounty whe2 the properry is located.
Fdirg Dates: 1) Real Pioperty: Must file durirg the year for which the deduction is sought.
2) Mo6ife /Manufactured Homes not assessed as Real Properly: Must file during the hvefve (12J months FE
6elore March 31 oleach year Ne deduction is spght.
C.
See reverse srcle /a addifional inshuctlons end qual'�fications.
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e on �ecord iv dMerent Nan that o( aPPOpnt a+Eicate Delav`
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Fdd�ss d rtp�a9ee ar mntraU se�er
Name m asvgnee or omg ow�er a na
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3 ❑20�unryrwdrtor
❑ County Recorder
COUNTY
Record numher Page number
- oD. S o 7
unpaid az of Mangage�l�Co `� 'uWebtedness unpaid as d � � t M�
date oi a
❑ Yes ❑ No
tt owned with someo�re other Ihan spause. iM'rate with wMrn
Is tl�e property in Questim: MnuaoyASSesseO
L� �a�+r ❑ ��r�
Moble Fiort�e (IC 61.1-�
cGy, sbte. a
'��12 C,� � �.�
>t assgnee (Cnum,oer' arM svee; ary, state, ana [lr totle)
.�i�/ � � ' � ' <
tit�ant own poprlty in arry aher It y�. what mu
Ind'ana? ❑ Yes
❑ No
om�, � b m� �,m
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y
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5igrenaed bya-�aimr
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I I We cerUfy under Ne penalry of perju � at the above
owner I mntract 6uyer of Ne atoremen ned property date applicauon is filed.
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Fu� resident adEmss of appGmni (numDeranE snee( tdy, state, entl LP catle)
3aAl 9.fv E �Glr/.�.,,pC, f> .�n/ rf 76G c�
Persm aufM¢ed Dy duty e�ecuted Pwer af Attomey m by IC 67. -12�.7
IfdAress W author'¢ed persw� (numbera� sbeey riry, state, anC LP cotle) .
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Date (month. dal: Y��)