HomeMy WebLinkAboutMortgage_Starnes^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
� FOR DEDUCTION FROM ASSESSED VALUATION
` � State Fwm a3709 (R71 / 6-09) � . '
S�.w f Presaibed by Department of L.oml GovernmeN Firence
INSTRUCTIONS:
To be (led in person or by maii with the Counry Auditor or Counry RecoNer of fhe county where (he property is located.
Filirg Dates: 1J Real Property: Must file durirg the }rear (or which the deduction is sought.
2) Mobile / Manulactumd Homes rat assessed as Real Properfy Must f+le dunng Me tweNe (72) months
before March 31 of eacA year tAe deducfion is srough[.
See reverse side foradtlitiona�i�slrucfions and qualiircafions.
MPGraen (ox+�erorco^v�^C� s9Ner1"cbons n^ r@�TiP2� el. .
�
If name on remrd
Nama o1 mortgagee or contract seller
T
r/ legal tl ption Retord num
�b-i$-3�-�+�4-000.y-ao-oo /i
Mongage / Contrau iMehtetlness unpaid az W Mongage / Conracl'viEebtedness unpaid az of
March t. n�rte�t7e@e7 _ _ aate o(appfmation
somearie other Ihan spouse,
County Recader
UD170F.
oe numCu
appfrontMe sole
r equitable OxneR
❑ Yes ❑ No
Is Ihe prapnity in Ques�on: MrniaDy Psusse0
❑ Real Pioperty ❑ Armuaily Assesud
AGdrea W rtaryagee or contraG seAer (numbe� aM street, ury, stete, aM ZIP code)
owner
Does epptinnt o-xn pnperty in any othu
munry m Ind'ena?
❑ ��
Deau�tian appfoved in Ne amount ot
za
U ry<
I / We certify unt
owner I mntraci
�
Ne
of
slate,
��. tt yes. what muM�? .I MR�et Taarg DiSirirl? Has ih¢ dedudion Ceen re9uested m DmpenY
No �--~. —. fortuereirtY�n � Yes
— D. doio-3/ oNo
— � 9�ax.n��o
L�� C� �a�� �— zo_
� ��3��� �O/ �
..��, ���,�. �Y �� ao i o
that the a6ove and foregoing intortnation is We and cortec[ arW Nat Ne applirant is a resident of Indiana and
U ed property on date application is filed.
Date (nmtli. daY• Y��
3 �
o� �rrb.,m. der rea,�
Mtlress of authu'ved person (number arq sLee; tey; state, anE LP oode) . I
Y