HomeMy WebLinkAboutMortgage_Reinbrechtn STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
__ FOR DEDUCTION FROM ASSESSED VALUATION
Sate Fwm d3709 (R17 1609)
�` ,.,� Presv�bed Cy Departrtietri af Latal GovemrteM Fitw�ce
INSTRUCTIONS: Fppprrr �ww'Qpeedd
To 6e filed in permn a by mail with the County Auditor or Counry RecoNer ot the county whe�e [he propeM !s bcated_ ., r F+ �t� [ � j �
Fi6rg Da[es: 1) Real Property: Must file dunrrg fhe year for which the deduclion is sought _`� counry a,daor
2) Mobde / ManWadured Homes not assessed as Real PropeRy: Must Re dunng Me tweNe (72J monMs
be/ore March 37 of each year the deducLOn is swght Co`nry Remrder
(.a�., ,G f'
See reverse side for adtlrfional instnictions and quali�catqns.
Mv�'(o»maaoonugpb�4'er-seeies�peqrao7re.erseside) J c I . i � 170R
As� rWue d real'p(openY a of
Merrh 1, arm� ytlr
nbu/legaldesaipom '
U - OD U , /
M�(I�yge/ Contra¢ 4dehtedness unpaiA as ot
Mam3� 1. arterrt year
If �w. whal b tus I her eraiY share Of intem_st9
1f riame m remd'o QRFerent Nan Ihat ot appOpnt. uMic
Nartre of rtnrtgagee ar contra�Y se0er
Pddrea d mortgagee a mntraG x0er (nuMar end sn
Name of assignee or otl�u owner w halOer d mortgage
AAarass ot assgnee (number and atree4 �l: stete. ana
Oo¢y e�nt wm property in any othc
counry in Irqiara7 � Yes ❑ No
Deduc6on aPWored'vi Ihe amou'v of:
20 20
R¢cory rpimbei Page numbri
or 9 � 6
ge / Cantraa mEebteOrress �mPaid as of Is ihe ap�t tlre
' apPfmatim k�l or equitade °""rYt
❑ Yes ❑ No
merne afrer Ihan soouse. udi�ata v.im whom
property in VueStion: Mrwa0YA45essed
eal aoaenv ❑ MnuaM As�d
Mohle Fbrt�e fIC 6
1RS. what munt� .I What Tadng D'atriti7 I Mas tl�a
for arter
- �� � (3 kEGu I , DA,��v �
- D�� K
requesteC m propeny
❑ Yes ❑ I
2Q -
= a��o-3s3� ,��,�.�Y
�
I/ We certify under ihe penalty of perjury ihat the above and toregoing infortnalion is W e end cortect arid Mat Me appli�ant is a resident of Indiana aixl
w�+er I contraG buver ot the aforemehtioned property on date application is filed.
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pn�wn (number aM sbeeG tily, sfale, anC LP code)
ate (monlh, tleY. Y��
iate (monfh, daY. l�a�)