HomeMy WebLinkAboutMortgage_Church--"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
= FOR DEDUCTION FROM ASSESSED VALUATION
n State Fwm d3709 (R71 / 6-W)
� 1 Presaibetl by Department of Local Govemmanl Flrence
INSTRUCTIONS:
To be filed in person w by mail with fhe CounryAudi(or or Counry Recorder o/ the counry where the pmperty is located.
FiNrg Dates: 7) Real Property: Must file durng fhe year for which the deducfan is sought.
2) Mo6ile / ManufaUUmd Homes not assessed as Real Property: Must file d�nng the rv+elve (72) months
6etora March 31 of each yea� the deducfion is sofxPub.
See reverse side for adtlitiona/ inshuGions arM qualifications. �
� rdue d mal P�P�Y az d
Mart3i 1, anmt Year
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II name m remN'a CAterent ihan Ihat o1 appB
File
Year
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CounryAu r
r/ desaiption Rem number Pagenumba
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Mor�gage / Contraa'uWebtetlness unpaitl as o( Mortgage / ConbaG'uWebtedness unpaiE as of is Ne appGrant Ne sde
Martli 1. a�rtent year Eate of ePP�� n �1/�� legal w epuBa6le ameR
� ' / �/1 . l .l,l J n Yes ❑ No
Name af rrortgagee or contract seqer / A /
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Address of mortgagee u mntract se0er (number and stree; ciry.
Name of assignee or other owner or hdEer ot rtangage
AEd2s5 of assignee (number ercl sbee4 �y. slafe, ar�d ZIP cod�
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S9�e
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yes, xiut counry/+
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Is the property in Question: MnuaDy Asussed
❑ Real Pmperty ❑ Atmually0.ssessed
hbdle Flartie (IC 6
NTat Tanfg DislriU'? I Nas this Oetlurlia� Eeen reques;eE m prope+ty
r� a,�m y�n n, n
Dra�vei• NO..�.�.°..9.-... 20— p— �°— �0—
Counry Date (mon�. OaY. Y��)
Card NO. ..�.y.-?.�"....
oing intwmation is we and cortect afM that the applicant is a resident of Indiana and
�lication is filed. .
ane stree4 aN srate, arM
Person aNMr¢M Ey tluly ezecutetl Power otAltOmeY w Dy IC fs1.1-t 1-0. /
Address of aWqr'¢Etl per.,on (numOerarM sveet, ciry, stafe. arM LP code)
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Date (monN, daY Y��
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