HomeMy WebLinkAboutMortgage_Higginson (4)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_. FOR DEDUCTION FROM ASSESSED VALUATION
State Fotm G3709IR71 / 609) .
, w. PresaiGed Dy DePM�N of Lad Govemment Fuarce
Ile rk i
INSTRUCTIONS:
To 6e filed in person w by mad with the CounryAUditor or Counry Recorder o! the counry wheie the property is bcated.
Fil'mg Dafes: 1) Real Property: Must file dunrg the year for which Ihe deduclion is sought.
2) MobBe / ManWaUUred Homes rrot assessed as Real PropeRy: Mus[ file durirg the IweNe (f 2) monfhs
befae March 31 o/exA year the deduction rs soight.
See re ers side (or additional instructions and qual,fications.
Ap ( O`o�{wntra� uyar - s�sUirtnrss m reverse side) �I (�i1'/I / M.nM'1 `/ Q
yUn
�
eraa
i
iemd is d�ferent than ihat ol aPp4an� LWiface bebw.
Name ot rtnrtgagee ar mntract setler
mno-aa
Name W assignee w othn avmer a
�,n � o�o�v �� �r wn«
im�?
❑ Yes
Oeduction app�oved in tlre artqunl
sbm,
� m I�iaye � c«r.�
Eate W appfxation
tt wmed with sar�ne aher Nan wouse.
��
IS I�IG �`/ 1f1 QIWSSIC
❑ Real RoPertY ❑
Counry Audimr
�adeownen
Yes ❑ No
.�
er at mortgage
�.—�, ����sc�v, �'ECl��C
— �ACNEU� �Ns��,�����„�,,
r, r� w� r�? r-i .,_ _ n
20- � p- � �-
N Cwmb Aud'rtcr
a�� ����
20 _ � 20 � 20
I�m
2p
I/ We certify under the penatry of perjury that Ne above antl foregoing infortnation is We and mrtect arM that the applirant is a resident of Indiana arW
awner I contracl buyer of the afarementioned property on date apPlication is filed.
(owne;� ma) � oate (monm. ear. r�n
�
p nt aCtlr¢ss W appfirant Der anE sheet tiry, sfateyand Z1P cotle) _ _�' '' '__
auttorized Dy dWy ezewcetl PowrJ af AuaneY or M IC 61.1-12-0.7
; of a Wmr'ved persan (num0er a� sbeef, dty, stafi. and LP cade)
Date (monlh. daY. Y��