HomeMy WebLinkAboutMortgage_Garrett (5)"'n STATEMENT OF MORTGACaE OR CONTRACT INDEBTEDNESS Coun Township vear
_ FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fortn A3709 (R71 / 6-09)
` Presaibed by Departmerrt o! loca� Govemme�ri Fl�arce
INSTRUCTIONS: n,m� -
To be hled in person or by mail with the CounryAud'nor or Counry RecoNer of the owinry whe�e the property is bcated- Q�1 � L
Filirg Dates: 7J Real Pmperty Must file dunng Ne year fol which Ne deducUOn is sought � Counry Auditor
2) Mobde / Manulacfured Hortres rrof assessed es Real Property: Must fiie dunng the tweNe (72) months �^ ����
6e(ae Ma/cA 31 of each year the deduction is soiyht i���„ ,e.
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SeereversesideloreddiUOnalinstructionsarMqualificatbns. � � ___,,,, ;,.,rv e11f11TOR
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Tadng DistruY Key �wm6er I legal desaiption (/
-l9-3/ - yoo -oao. � 1 / - o 0
0.sesed vdue oF raal piopaty as d A1�rtq� 9e / Contrati IndebteEr�s unpaid as af Mwtgaga I Con1
Me�rl� 7. nrmLL year Merd� 1, wrteM yeer tlate of aPpfimb
/ 5 Oo
�� �a, wfiat is n's � trer eua share or incerest7 rc oM,red witn wmrone m
If nartre m 2mN is Srttuent than ttat ot a0popnt, uarv� oeww.
Name of m�ga9ee a mntrati seAer � ' n�
µ�
Pddress of morcgagee a conVafl seDer (men6e� and street �l: sm�. aM LP code)
Name of assignee w ot�er awner or holder ot mMgage
AGCrPSS ot assigtree (ntm�ber aM streeG rdy, smte. entl L e) ,
/ �
Oces eppfrvnt wm pmperty in any other It yes. what muntYl What 7a�vng o
munry m Intlia`u? ❑ Yes
❑ No
GOUNTYAUDROR
Deduction aeoroeetl in Ihe amount oF:
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I I We certify u er Ne penatty of pe�u Ma
owner 1 mntract buyer of th forementionec
/��n /•Y
FWI r2esident a/Gtlr�s�s^o1 appfrcant (num6erantl stree4
^/fl b .J . ���
Puson authmn�d by MiY exttu:ed Powei of Avorne•.
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sparse, u�drate Wih vAwm
�Itabk o+rtwfl
Yes ❑ No
certY in Gunstian: M�u+aM Assessetl
Roaero Qa,rt,uanywssessed
Dra�r�er NO.c.�� I.Q........ ,o
Card NO....S-1.��.1...........-
�133,000. `Q� —
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Ne above and foregoing intortnaUon is true and cortect and that Ne appfkanl is a resident of IrWiana aM
G�nY on date aPWiption is filed.
_ Dam (�. daY. Y�A
'-_^'i.�.l
person (number aM sbee; c4y, sfafe, antl ZIP oode)
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