HomeMy WebLinkAboutMortgage_Bennett""* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ , FOR DEDUCTION FROM ASSESSED VALUATION
(, � j Sfale Fortn A3709 (R71 / 6-09) � � ' �, �
yu PIPSGibetl by DCpartrtl2M 01 LOqI CaOV¢TT¢llt Fit�B(ICC �
File Mark
INSTRUCTIONS: .
To 6e lled in person or by mail wi(h the CounryAuditor or Counry Recorder of the counry where the properry is located.
Fitng Dates: 7) Real Property: Must fJe dunMj the year for which the deducfion is sought.
2J Mo6de /Manufactured Homes not assessed as Real PrupeRy Must fife dunng the twefve (12) months
be7ore March 37 o(each yearNe deduction is sought.
See reverse ' e 7or dditinnal instruc6ons and qualifications. G L
AppGca ( 6uyer- ee o 2v s'r/e) /�
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'�9 KeYnumberlJagal�esm'ptaap —/ —oO�•'� �'O�
J/ 1.1
�.� �o ��
vWUe of real pmpeM1y as N Mortgage / Conbau intlebte0ness unpaiO as ot Mortgage I ContraC inEebtedness
Ma�d� 1. ar'vrt year Ma� 1. artent date a( appGcation
f 0 �
tt ro. what fs his / her exaU share ol intsest? If owne0 wiN someone other than spouse,'
tt narne m remN e Ciflgent lhan Nat W aDP��. �irate Gebw. Is Ne�,p
m m�uxt
nearess ot mMyayee «mnuaa smer
Name ot assignee m aNel awner v halder of rtvt9age
�Y• smf� �rd LP oode)
PdCress at asvgnea (numbar aM aaeel, ay, sbm, eM LP code)
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Oces applimm a.m property in arry oNC ._ :Ta�dfg Distric
counryinlMiana? n_ �� _ .
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DeEUC9onsDWovec . � I ..........•
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Caunry
Counry Auditor
CounN Remrder
Q `!'1 a/Of�
unptid as M Is the applkant Me sole
legal w eWitaNe ameR
❑ Yes ❑ No
u�dicate with M1wrn
roperty in puestion: Mnua�y AssesSed
ProPertY ❑M^�a11Y�
Has N"s dedur�an Eeen reVUrsied m P�PP+�Y
for wrtent Y�/.+ ❑ Yes
❑ No
F,���w
1 I We certify u�er Ne penalry of perjury that the above and faregoing infwmalion is W e and corterl and that the applicant is a resident of Indiana ard
owner! contrad buyer of the aforemerrtioned property on date applicalion is filed.
�pature (owneGS/�9 nam4)l Date (monN, daY. Y��
�revEent atldr�s of appfimnt (number and sbee4 �1: ��e, and ZIP oode)
yoZo v!tu.Ey PRSS HAU�s'�or
Person auCq(aetl by CWy ezecuteE Power of Atforney w by IC G7.1-12-0.7
person (number arM streat. rily, state. arM LP mde)
63a
o� v�,u�. ear, r�n