HomeMy WebLinkAboutMortgage_Alston^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count
� FOR DEDUCTION FROM ASSESSED VALUATION
- State Fo�m d3709 (R71 / 6-09)
�' ,�r f PresciCed by DepaRmenl af Loral Govemmanl Finance
INSTRUCTIONS:
To 6e filed in person or by mail wifh the Counry Audito� or Counry Recorder o/ the county whe2 the property is located.
Fil'mg Dates: 1 J Real Property Must file during fhe year for which the deducfion is sought.
2J MobBe / Manu(actured Homes irot assessed as Real Property Must fife dudng fhe tweMe (12) months
before Maich 37 0! each year the deduction is swght.
See reverse side !o� additional instrucGons arM qualfications.
nppfirant(o rwcontraebuyEr�sge reversesitle) � �� A ��
�raWe d real pmP�Y �
1. artrmt yrar
�( M. W�Id� 6 �115 � ilel BY2f2:iNK
�ilIdII1C Ofl fCGdli 6�fCliYl� 1�121
��wa��o
that ot aCP��i• uidi�ate Debw.
cpntractse0er
neares or morcgayee «mnvaa sener (i
Nam¢ of assignee w oNer owner or holdi
PdOrew of assignee (nvmber and sfree;
pces gpplirdnt cvm property in any oNu
counry in IMiana? ❑ Y�
appiwed'ui the amauni
wJ and streel, ury. state. aM
mort9a9e ' _ _
❑ �L6Gn�ilYe'deW�
Remrt1
I ContraG i`Web[edness unFaid �S of I Is Ne ePdirent Ihe sble
pfic�ation le9al or eQUitable wrtM
❑ Yes ❑ No
one aher ihan sP�. iM'vsfe with wMrn
Is IM property in puesUOn: MmiaDy Asses+ed
❑ Real Pruperty ❑ Armually Assessed
Mohile Home (IC 61.1-1
my, saze. arx
.. � . . .!- ' _
I Dra���er \'O`a�/� �
❑ No ........ 'c
Cal'CI NO. .. �.�9�....�..... -
Z'.9�. �. �ay5,taoo• —
reduested m G��Y
❑ Yes ❑
yp_ 2p_ 20_ 20_ 20_ 20_ 20_
nawre W Coimd AuEitor Caunry �aie (/rmM, daY• Y'��
I I We certify under Ne pe�alry of perjury that ihe above and foregoing infortnatian is We and correc[ and Na[ Me applirant is a resident of Indiar�a a`W
owner / conVad buyer of the aforemenlioned pro e n date appiicatlon is filed.
.....�..e i.,�.,.,e nn.n,.�o� Date (monM, daY. Yea�)
esidan�address of appGrant (number�q sfree4 dty, slafe, anC LP ca
IlBSo So�i �+ IR�NC"rsu�,KCf �
x� au�M�aed by EWy exew:etl Poxer of AtlorneY ��' IC 67. t-12�.7
ess of aWrorrzed perso� (�umber arb sDee1, �ity. sfafe, and Z!P wde)
, oa� c,�. �,,�an