HomeMy WebLinkAboutMortgage_May (5)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun o shi r
__ _. FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fortn d3709 (R71 / 6-09)
S 1 Presaibetl M DeP��rd of Laxl Gmemmem Fuarce
rr
��srRUCnoNS: ��� 201
Fortn f�ed with:
o be filed in person w by mail wifh the CounryAuditw or Counry Recorder o/ fhe county where tAe propeAy is located. C �
Filing Dates: 1f Real PmpeRy: Must file dunng the year for which Ihe deducfion is sought. � �q ��p�
2) Mobile /Manufecturetl Homes rrot assessed as Real Property: Musf fiie dunng Me fwelve (12) months n
6etore March 31 of each year the deduction is srought.
GIB ON`C�UNTY AUDI OR
See reverse side Por additmnal inshuctions and qualT'ications.
an�n�! .rermntraebuver-seeresLictonsmreversesdel �i .� �
rasyg o�atrc� /e I(ey n�mner � legai ees ri oon
szia �J . L�
41sesseC veW VoP�Y as d Mor(qa9e / Contraa
1fard� t. aaren r Martli 1. a�rtent y�
r bo
1f no, what's his l lrer e>aU share ot interrst?
�( name m remE is dirte�ent ihan Uat W applifan4 Ndinte Debw:
Name of rrortgagee a mnttacl seller C
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Pddress of mah7a9� w mntracl sWU (nurMrf and sheel, crh: sbte.
Name of assignea w dher owner or Imidu of mort9a9e
Add2ss of asagnce (numDeraM sVeeC rdy, slate. aM LP mtle)
Dces"applimm oxn ptaperty in enY �� If yes. whal tc
counry in IMana? � No
❑ Yes
'
Deducemi anwoved in Ne amount ot
2Q � 20 � 2q—
RMnlA M
- h-d0at I
��ss unpaid az of Mwigage I Con�ct iMebtetlne�'.s �mGaid a
tlate of appfi�tion
i
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PZ�7
W�at Taprg DisUict?
p
eQWtable awrrYl
] Yes ❑ No
Is ihe popn,rty in qunstion: Mnua�y 0.55e5uE
❑ Real Pruperty Q ArmuallyPssessed
Nas Na tleEU�lim
for curRnt yeaR
20
oa�e bnonm. dar.,ean
� v�r
❑ No
20
I/ We certify urWer the penalry of perjury that the above arW foregoing mtortnatlon is We and correct arW ihat Ne appiicant is a resident of IMiana antl
ovmer I mntract buyer of ihe a(wementioned property on date appliralion is filed.
3na� ('a^wnne/s hAreme) ( ��q Date (�mN�, daY. Y��)
/ �' I/ //t . ✓ � `Y ///r. • �. ��' /�' �� � �
state,
person (num6eraMSDeet,rity.sla(e,andLPOOde)
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