HomeMy WebLinkAboutMortgage_Epperson (3).f STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form G3709 (RB / 2-07)
�' „a � Rawibetl by Dapanment M Local Govemment Firence
INSTRUCTIONS:
Fding D� s�Real Proyperty: Du g the 12 month sbe7ae Jne�7 W fhe yea �the d�'ucbon ls o ba er��. ��g 1 3 2009
2) Mobile Homes assessed `mder IC 6-f. f-7: Behveen January 15 artd Ma�cA 2 of the year the dedu is to be eNecfive.
See reverse si�/or add�l insWctions a� quaGfications. n� .
� �m o( Y/���n ���. / � / Reco`d � P� V
popaly az of Marrh 7, arrent ymr A/atgage�onUad indebtedness unpaid as ot March 1, Is Ihe applionl �he sde legal a equ�Iade wrtre(
anrenl�e,i
� �500'O ❑Yes ❑ No
u r.,,—«rel rs nis � rrer �aa sro.e or imeresn I I u oxneo ..�n someone ar
if reme on recrnd is d'd(eran Uian Nffi oF applican4 �����e be�ovr:
mortgagee or cpNacl
of morlgagee a cmtrati sdler (num6er an0 s6ee( dty. sfafe. ard LP code)
assgnee w oltier owner w hdder of mortgage
� Address of assignee (�er aM sLeet. cily, stafe.
Dces applicant am p
courrty m Indana?
o�����-
20 �
SgnaWre of Cwnq
I I We certify um
na and own
s o�er
, 0 sdenta ress
��� v
Person aufhaaed bv
operty in arry dher I If yos. whal counl�� VYhal Tadng D'aVicll
❑ Yes � No
- � 1NTYAUDROR
_ oQq_ I�y
�Dl�„�CL � •••� . _ 20
C�Cd��• .. • ' ' ca,,,,�,
D�
a
spouse,
is Ne property in queslim:
❑ Real Pfoperty ❑ Mobile Home (IC 61.1
artent
20
been requestetl on poperty
❑ Yes ❑ No
o� ��w. car. r��
20
_�� aoove and foregoing infortnaUOn is We and cortect and that Ihe applicants was / were a residenl oi
�erty on March 1. 2b
Date (manlh, daY Y�A
dty, state,
streeL aty, sfafe. and LP mde)
� ��
Dale (mm(h, day, yea�