HomeMy WebLinkAboutMortgage_Brown (12)� � po.�, � �, �
"'n 5TATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS c rown i ear
_ FOR DEDUCTION FROM ASSESSED VALUATION �
Stata Fam d3709 (R11/6-09)
S,,,, � Fmsvioea ny oepartmerrt ot w�sl Govemmem Rrence
wsrRUCnoNS: DE ��� ��@O10
To be h7ed in person w by mail wffh the CounryAUditw or Counry Recorder o/ the oounty where fhe property is located. F� �� �:
F�7irg Dates: 1 J Real Property: Musf fde durrrg the year (or which fhe deducLOn is soughL y% Q�ioN quditor
2) Mobde /Manulactured Homes not assessed as Real Property: Must file dunrg the twelve (f 2) marths �o /y/np'� ¢r�rd
6efaeMarcfr37o/eacAyEarthedeductionissaght GI9�QYCOC:':?1F.4UJI�UH �
See reverse side (or adtlifional inshuUions arnl qualifiwfions. �
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Q.,.d`'a'�C�
Assessed va4�e aFreai pfaperty as ot
IMa�d� t. ur�ent year
rc m. what's his / her amct share o
If name on �ecroN b QAlerent Ihan tl
Name of matgagee a ntracf se��
Address of mort9e9� w mntrad s
Oces eppHrvnt own property in eny i
munty in IMena? ❑ Yes
Deduclim app�rn.•E in the amount oF.
',oZa.3�0 6—d�OD —QDO — Q// 1009 ��� P(pn3 Jv
Mortpage /N� �'ude6teE�ss unGaid as d tlM etga9�� 'uMebtedn�s imCaid as d Is�Ne ��� �
rd�
a, � Q Q� ❑ Ye5 ❑ No
If owne0 wiN someorie othu tlian sPa+�. ifdicate with wfwm
R htdira[e below. Is the P�GertY in Questbn: Mrwally Assesud
� Real PtoPeKY ❑ Mnuall�'. A�S=a . _
Sps end streef, ciry, sbte, eM �
mortgage
stefi. and LPI�
If yes. what munt�t
I No
20 � 20 _ � 20
��
I I We certify under ih�penalty of perjury
owner / mntraq buyer of ihe aforemerttic
�renne jowners hAl rame) :7
��
20
What Taarg D'atrict?
20
�G�-� / 3 c'
n°"- --
(p - 1�330
�ii a�,�
�e above arW foregoing infortnation is true and cortect arW Nat Ne appii�ant is a resident ot Intliana aM
property on date appiication is filed.
ary, stata,
bY
AAdrass W aWror'ved person (number arM sbcet, ciy, state, aM
�
Date (rno�Nh.