HomeMy WebLinkAboutMortgage_Dixon1 "'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Towq Year
, ; FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fartn A3709 (R71 / 6-09)
�' ,.,. � Fresaibae by oepartmem W lod GovemmeN Fnarc:e
Fle Mark
INSTRUCTIONS: N
To be h7ed in person w by mati wifh Ne CounryAuditor or Counry Recade� of Ne counry where the property is located. � �
FTmg Dates: 1) Real Pmperty: Must file during Ne }rearlor which the deduction is soughG �w q�d��
2J Mobr7e / ManufeUUred Hanes not assessed as Real Pioperty Must fi1e during the tweHe (12J monNs l.. �S �
befae MarCh 31 of each year the deduction is saght. � �°4�Y R�b�
See reverse side for addifzinal inshuct(ons arM qualifications. GIBSOh .. '.: .. .. .
Appf�merormMaCbuyar-seerestrirYiwrsga�rererseside) _ c .
0
tl narne m iecatE
Name o( mortga9ee or mntrsct seller
Add�ess of nqrtgagee or mntraa sr�er (numbar ar
Name of assignee w othu wmer or hdCer M mort�
AAdRss �f a�gMB ���mber end Stree� �Y 57Bte,
Dces aPplitant own property in eny other
munry in Intliana?
❑ Yes ❑ No
DaducEOn app�aved'o� Ihe amoum ot
�
Signanne d Camb nu0itcr
whatcountyt
20 - � 20 - � 20
Rtmrtl nurt�Cei
'• d � 00 �J/0
as U Mongage / Contrae iMebtetln¢ss un7� as d k
tlataoiappOntion , i B
smneone
Whal Tad�g D'¢iri
20 _
Yes LI No
is C�e D�GenY in question: Mnua%PSSrsseE
�Real ProPenY � ���N �
Abdle Home (IC 61.
� 1 �lp��
pi-a���ci• NO....�(�.......
� �. .. . .. . . 1.�.�.T• .. . .
C:ll (1 •
_,. � 20
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I/ We certify under tha penally of perjury that Ne above and foreguing intortnatlon is true and mrrect arW that fhe appli�ant is a residertt of IMiana aM
owner I contract 6uyer of ihe afwemen�mad property on date appliplion is fiied.
I�D+Y+'iPwnefsliAnary@) /� . Date (rtm�. daY. Wa�
� I Fup
stree4
Date (imdh. d2Y.Y��
MEress ot auCmr"¢eC person (numDeraM street dry. sbte. enC LP ootle)