HomeMy WebLinkAboutMortgage_Davis (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
_ : FOR DEDUCTION FROM ASSESSED VALUATION
.• State Form C3709 (R71 / 6-09)
,• f Presvibetl M�V��rLL of Locai Govemment Fuance
Fle Mark
INSTRUCTIONS: U E C F �� �:
To 6e filed in person a by mail wdh !he CounryAuditor or Counry Recorde� ot the counry where the property is located.
Filing Dates: 1) Real Property: Must fite durir�g fhe year for which the detluction is sought �; County Auditnr
2) Mobde /Manu/actured Homes nol assessed as Real Property: Must file during the fwelve (12) mon�`/� �
before Marclr 37 of each year the deduction is sou9AG � County Recorder
Seereversesideforaddifiona/insWCtlonserMqualifications. GI9SON CO �
AppGrafn(owner ar� byer. see resfic�ns m mverse si0e)
Ger / le9al desaiption
_ aa- �a-3oo _ooa. 3Y5_� ac�
M1lnipage / Conbaa Intlebte0�ss unPaiE az N Mongage / Con7atl mEebte
Matdi 1, wrte yrsr Eate of eDp�fion
�D Dn D
11 no. wha� s his / her e�ma share 0( inte�¢st1 '
If rwrie an recorG is Eiffereni Nan Nat of app�cartl, mtlinte belovr
Name of �rortgaBee a mnvaG se4er
. T��
Aildress of mort9a9ee w conttxt seAer (nwn6er ard soee4 �Y. sbm.
Name a1 assignee or othrJ awner or hdder ot mortgage
Mtlress W a;�ee (numbu ar�tl stree4 �Y. stale, and LP code)
Oces Bpptipnt awn property in any oNu
munry in Ind�aria?
❑ Yes
DeducCOn appioved'e� tice artaunt o`
No
If yes. what count�/.�
Zo— � p— � zo_ � zo
ire dCamryMWiwr
I/ we cert'rfy u Ne
awner I mntract buyer
�� (axnerSlWrertre
orrN D.
o �oc aadr� w �r
��
If owned with mmeorre aher Ihan sP�a. 4dicate wtth wMrn
numCel
osv
idade am�+
Yes ❑ No
Is the pioperty in puestim: Mnua%ASSessetl
❑ Real Ropetty Q Armually Pssessed
�D'�y'./—
4Mat Tadrg Disv'xY? Has M's deductim Oeen requested m p�aperly
hr avre�V Y� r-� .. r-�
fhat Ne above and foregoing infwmalion
ned property on date application is fited.
'4 trN, s$re. antl
.c/w.�a
Pdtlress of aNha'veE person (number aM sbee4 �Y. s+ate, an0 Z!P code)
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