HomeMy WebLinkAboutMortgage_Ziliak"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
__ .- FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn G3709 (R71 / 6-09)
�' � Presoibed by DepartmeM o( Lx21 Govemrtlent FilanCR
� F'
WSTRUCTIONS:
To 6e filed in Y �Y �Y h P�PeRY is cated. Fwm ed '
person w b mail with the Coun Auditw or Coun Recorde� o! the ooun where the
Filing Dates: i) Real Pmperty: Must ble durrrg Ne }rear (or which the deduction is sought. unry Auditor
2) Mo6Ae / Manufactured Homes rrot assessed as Real Property Must file dunng the twelve (12) months 1
6e(ora Ma�ch 37 of each year the deducfion is snughG N O V 1 Z��Ty Recorder
See 2verse side tor adtlilional inst/uctions arM qualifications.
�
r���
� i� �
1�
�������
amn[year
or contrar2 seller
ZJ
co�o-aa
beww
Address W nqR9agce w mntrstl se0er (number and stree4 Nry. sb+e.
Name of assignee w oNer owner m htlEer o( morn
Address of assignee (number aM wec4 dry, sfate
Dces epdimnt own ryoperty in any oNer
muNy m Intlia�u?
❑ Yes ❑ No
DeCUCOan appmved In ihe amount of:
2� _ 2�
Signature d CounN Auditor
f��I
az
Drawer NO..D�.Q.Q�.......
Card NO. ....�-�..101o. � .......
� 35,a5� �
Counry
��
"uWebteErress unpaiO as oi
w
Yes LI No
Is the property in 9����: �nually hssesud
❑ Real ProGeKY ❑ �!!�Y �
s Ihis deAud'wn Eeen
wrte�n yrar.
20 _
�ate (rtmnN, day, yea�
on ptoperty
❑ No
20 _
I I We certlfy under the penalry of perjury that the ahove antl toregoing infortnalion is We and cortect and that the applipnt is a resident of Indiana arW
ovmer I mntraa buyer of the aforementioned pmperty on date apP��lion is filed.
itawre fyyners M}name). �. ^ . � � � oate (mmth. daY.Y��
executetl
state,
�y IC 61.742-0]
AOtlress of autharzed person (number arN sbeef, cRy, sfate,