HomeMy WebLinkAboutMortgage_Adamson"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_,_ FOR DEDUCTION FROM ASSESSED VALUATION
• Stafe Fortn A3709 (R71 / 6-09)
�' ,.,� � Presaibetl M�Pa�rit of Lofal GwemrtreM Fnance
lNSTRUCTIONS: �o
To be filed in person w by maii wilh tAe CountyAUditor w Counry Recnrder o/ the counry where the properry is bca[ed. C � L �)�
F�7ing Dates: 1) Real Property: Must hle durng the year Por which the deducLOn is soughG County Audimr
2) Mo6Be / Manufectu2d Homes rat assessed as Real Properly Must file dunng the fweNe (12) rtwn[hs �nry R���
6efae Ma�ch 31 0l each year the deducGOn is sought ` J 0� '
See reverse side foradditional inshucGOns arid qualfications. �,__ _ �/ (J''
ed rdWe d re� piaperty as W
1, nlrent year
rc m, wna� ts nis � t�er e�oa
If name m recad is dMe2�
r kgal d� 03 -� -000. ma- o a�,t Record nurt� O Page 9u(nb�s �
l0 � � ,
Mbrteage / Contraa indehtedm�ss unpaid as of Moriga9e / ConraG tr�debteeness �mpaid as M LS the eppkant the sde
Memh 1. anent year �(J /'1 ^ O� data of aPP��� kgal or equitade ox+ref7
�� 'v� U ❑ Yes ❑ No
It awne0 wiN someorie other C�an spouse, indicate with wtpm
�, hWirate below: Is Ihe property in question: MmiaMhssessed
❑ Real PfoPeKY ❑ M^uall)' Ass�sed
e�oa� r�o� nc ��.i=
�����a�,�� � 5 r�
neatess a rtnrtgavee «m,vaa s� (,nmae. e,b saeec �r. s��e. a�a:
Name of assi�ee or MMS w�m1 or halda ot mortgage
Aila�ass ot as9gnee (numOer eM s�.r' .-�. _�---
-A�/�m C�L � s� ��
� —
ao��-� s.� �
�� � �
'"1 I We certify u�Wer �he penalry o ryury that the
W
owner / contracl buyer ot the meMioned pra
Sig^aWre(nMnCrSfi�reme) .
resitlent address
r•�
WhatTad(g
AUDROR
; �his tleCw]im Oeen reCUrsted m p�aQeM1y
wrteM Y�r? � Yes ❑ �
2� 20 _ 20 _ �1 _
��H ����. �Y �2-�o-�a
rW foregoing infortnalion is we and correa aM that the applinnt is a residerrt ot Indiana and
date appliption is filed.
Da[e (month, day, y�
rey or Cy IC 61.142-07
dry. 5fa(e, and ZIP Code)
7
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