HomeMy WebLinkAboutMortgage_Meny (7)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou owns Y r
_, : FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Fwm A3709 (R11/6-09)
� w. � PresvibeO Dy DeGa�nt of Loral Govemment Finance
ile a
INSTRUCTIONS:
To be filed in person w by mail wifh Ure County Auditor or Counry Recorder of the county whe2 the property is located. �� ���,
Filirg Dates: 1 J Real Property: Must hle durrrg the yrear fir which the deduclion is sought. Coun�P.uditw
2/ Mo6i(e / ManuFactu2d Homes not assessed as Real PropeRy: Must file dunng the hveAre (12J month�IBS N N��' ��ef
before March 37 0/ each year the deduction is sought.
See ieverse side for adtli6onal insWcfions and quali�cations. ..
narent yrar
5 hi5! hG
s.�
wrtent
It �wrie m �emN ¢ diRwent Nan that of aPP��L h�7ipte bebv`
Name oi rtnrtgagee or crntract uAer
Pddress of mortgagce n cmtracf seAer (num6rl and snae4
0
� 7� � 7
s unpaid as of gaqe / Contract indebtetlnrss unpaid as W Is Ihe apd��� Ne sole
date of applimfiwi legal or epuNaWe rnmeR
❑ Yes ❑ No
If awned wiN someo� othr! Cun spouse. 4Wimte with whom
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�i".l�YCI' \�... ��
' mneJ mmer rn maer rn meruyyn Q �7
(numae. ene spee4 «n, s+ere. arie ZIP cneel C II 1' (1 \ O • . . • • • . ! . !• � 1• • . . • •
��til��'�i�
property in eny oNer 11 yes. wh:
❑ Yes ❑ No i I
Deductim appmveE in tha amount
20 _ � 20
Sig�anue ot Co�mN Auditur
E'i9
JUNN AUDROR
20 20
Counry
Is Ihe V�PenY in VuesUm: M(wa0y Assrssed
��.�a�m 0,�,�y�
0
--' .�a deduaim 6een repuesteE m pioperty
v a�rent yeaR ❑ Yes ❑ No
20
Oate (monfh, daY, Y��
20
I I We certify under �he penal�y o( perjury Nat Ihe above arW foregoing infortnalion is We and correct arM Nat Ne applipnt is a resident of Indiana arW
owner / contract buyer of the aforementioned property on date application is filed.
»Wre (a�ei s fiAnemel . Date (month, daY.Yae�
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\Fu'll reside�n^t adCmss d �ap(�
l l Ll� C
�Y•
IC 61.1-12-07
of author¢ed person (number ard sveot. ciy. sta(e, and
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