HomeMy WebLinkAboutMortgage_Bow^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ou s Year
__ s FOR DEDUCTION FROM ASSESSED VALUATION � �
• ' • State Fortn C3709 (R77 / 6-09)
�' ,.� Presaibed by DepartrneM a( Lmal Govemment F�urr<
wsraucnoNS:
D E C 3 f���bad�
To 6e filed in rson w 6 maii with the Coun Audita or Coun Recortler o/ the coun where the Fam Aed w'tl''
ae v ri n ry v�venr u i�ca�ed.
Fiiirg Dates: 1) Real Property Must file dunng Ne year lor which the deduction is sought �'/4 �fj���unty Aud"rtor
2) Mobde /ManulaUuied Homes rrot assessed as Real Property Musf fJe dunng the twelve (12J montXs � �{�� ry
befora March 37 oteacli yea�the deduction is sought. pI830N CO NT'MUDITpR R���
Sea raverse side (or additional instnxtions and qualifications.
npp6 m(owneraconuac�6uyer-seeresvic0ass,qireversevtle) .
ed vad�e of real PopertY as ot
Yd B
�. CI�CY yCN
n no, wl,at b his � ng eme sl,are a inte+est?
If nazrie on reN�tl
rem tl
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Delow
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nqrtgagee or mntraU srAer (number and sLeeS uty. sfate.
Name m asignee or ourer owner w hddu m rtprt�aye
A4dR55 of assignce (num0e� ar�tl Snee; tlty. Slefe. erM Z/P code)
Dces eppliont o,m poperty in any
munryin Ind�a? � '"
Remitl number Page numbri
ao ,� c� � so
Y� u No
If awned with somea� aUrer ihan spouse.
i �
Is ihe pmperty in questic
�Rea1 Ptopertyr ❑r
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D�-z�,-��- �°o._ aoib
Card NO`.•...�0�`-�ND........
� /3v, a4�o.c� �
COUNTYAUDROR
Deduction app�wrsd'ui Ihe amouN oF.
20 _ 20 _ 20 _ 20 _ 20 _ 20 20 _
Sy�awre d Camb AuOimr � Counry Dete (rtmlA. tlaY• Y��
�I I We certify und the penaly of pe " ry that the above antl foreyoing informatlon is W e and wrrecl and Mat Me applicant is a resident of Indiana ard
owner I mntraq r of the aforem rrtoned property on date appliration is filed.
(ownefz (ug na Date (nmth, dey, ym�
t�".CiC'
Fu revdent eOEress of appGcant (numder arM s8ae4 �: sbte, and LP mtle)
�zza�-�c.��r�r2 Nac� s�1��,�D, ��c��9
Penon auNOrired Dy Euty executetl PowvJ of AllomeY or Cy IC 67.1-12-0.7 Date (rtinnlh. tla}; yea�
Addfess Of autlta¢ed person (numMr erM SIIee4 �: s7sfe. Bnd ZIP Coda) ,