HomeMy WebLinkAboutMortgage_Trader^^n STATEMENT OF MORTGAGE OR CONTRACT INDI
__ _, FOR DEDUCTION FROM ASSESSED VALUATION
_ State Fartn A3709 (R77 / 609)
,,.,. PresaiCetl by DepartmeM of local Govemrtrent Fnance
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INSTRUCTlONS:
To be filed in person w by mail wifh the CountyAUditw or Counry Recorde� o/ the oounty where the properry is bcated.7 F.c�y-u��
Filing Dates: 1) Real Property: Must file dunng the year (or whicA the deduclion is sought. Counry AuEitnr
2J MobBe / Manu/actured Homes not assessed as Reel Properly Must fiie dunrn� Me twelve (��$�t� COU D�TO R
before March 37 0/ each year the deduction is saght. nry Recorder
See reverse side fnr additional insWCflons arM quali�cafions.
AppfcantLmmeraraontrarlOiM?r-seercstr&Aoruonreve�eside) n.. _ °-/ .
Ia�a ois �trct ' Key number / leg
%9_ !� a
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w�a�d���yasm nw�
MarUi t. anera Year Ala�d
Ui
tt no, what is his / her eraU share ot inffirest?
u rwr�e o� rema is ameren� man mat or avW�t �,du
Name of rtnrtgagee w mnttact seqer �
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Address W nnrtgagce w mntraU seAer (number and st
Name al �ee w ahu ormer or MNer of rtprt9age
MdresS of a5signee (n1�m6erand 5free; dry, 5lefe, enc
Oces epplirant own property in any o�her
�,�cy �, i�a�a
,. ❑ Yes ❑ No
20
synanne of
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:/ Contraa IMe6tedness unpaid az U Mongage I ContraG "uWebteEness unptiA as of Is Ne epplircant the sok
a�rrent year tlate o( avP�� �al w eWBade axrrel)
7�[-{ 7 lj ❑ Yes ❑ No
xeS �: sbfe, aM ZIP code
ZIP mCe)
H yes, what couny?
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2�
If owned wiN someone aher Ihan spouse, iMimte wtrh wtom
Is �he properry in qurs�on: MnuaOy Ass�tsed
�] Real ProPenY Q %���Y�=d
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C�C(i 10- ........ ..
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�mpeny
❑ No
I/ We certify under the penalry of perjury that the above and foregoing infortnation is true and cortect and that Me apptipnt is a resideM of IrWiana and
owner mntrad buyer of the a(orementimed property on date appiipiion is filed.
�naW oxne/s7uUipme) Date (monN, day, yee�
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0 rnsitlent aEdrnss of appfcant (number antl stree( rity, atafe, and ZI �ootle)
Pe�son
PowerUAitomeyrn by IC 61.1-12-0.7
Address of auUfd'aed persan (number arM 5bee; Uy, state, an0 ZIP mtle)
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