HomeMy WebLinkAboutMortgage_Fleming (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi Year �
._._ � FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn d3709 (R71 / 609)
� wu � Reuribed by DeparUnartl d Ln�l GwemmeM Fnance
Fle Mark
INSTRUCTIONS: �
To 6e filed in person or by mati with the CounlyAuditor or Counry Recorder o! fhe county wheae fhe property is located. ���
Fi/irrg Dafes: 7) Real Property: Must file durirg fhe year fir which (he deductlon is wughL � Counry AudiNr
2J Mo6de / Manufactu/ed Homes rat assessed as Real Property: Must file dufirg the twelve (72J months 1''I �,t��
before March 31 o7each year the deduction is soughG (�y. .c�vr �Remrder
/
See revarse side Ior additmnal inshuctions arM qualilxations. gSON CaU T -�- �-
t(owrrer ar contrarl buyer - resnicGOns m rere ') .
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T' D' ' Key rcrnber / legal desa�tion Record number Page numOPi
�o - - oi - o-ooc�. s3 �- oa
ralue U real property a of Mor�pag e/ Contraa irdeMednass unpaid as d MoRgaqe I Conbaa iridebtedness im0� as o( Is the aP�� iha sde
Merct� 1. �vmit year Marth 1. a�rent yeer data of appGCation legal or equRade wmM
.r�J
tt rame m remra "s Srtferent than that ot applkant, mAicate beb.r.
Nartre of rtrortpagea m m�varl se0er
Addres o1 rtnrtgagce w mntratl se0er (�
Name of asvgnee w other ownet w hdd�
AOOress of ass's,p�ee {pu� and�treet,
�' L
Does appliont awn pmperty in any aNer
munry m Ind'ana?
❑ Yes
���,������of
� �
ffi�,
YES LJ NO
�Is tlre P�PQrtY in Questim: MnuaOy AssuseE
r-'lRea� a�oaenv ❑ n�,�,�a�q assessea
n..u.......nre
dry, slate, aM LP cotle)
cJ �-Y - l. 7 3 a A c
If yes, what counfy+ What Tabrg D'¢victl . Has tt� �n Oaen requesteE m Wapaty
No
�
(ot mreN Y�? � Yes ❑ �
��N, -Fixm�G �KEU�s I�,u�
zo ��3 �3�,�,� �'/aa �
- .s�a,��� —
,..y. / , `„� [.... �{� Jt�l
K.J
I/ We certify ur� er the penalry of perju that Ihe aDOVe aM foregoing intortnamwi o �k a�� .. ..............._ ..._. __ ,_
owner I contract buyer of Ne a(oremerrtioned property on date application is filed.
F.Ib (ok+re/s7u0name) Date
��n A�� ���,.�s
Full iesiEent aEdfess of appfi1ant (number antl street, ' a, aM ZIP ootle)
1I�1 W S2 CO$ `�C��, 1l�-1 �.^1C93`'l
Puson auNo�tl Ey dWy exeaitetl Power of Attomey rn by IC 61.1-12-0.7 Date
verson InumDaraid snee4 u�Y. state.
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;nt of Indiana ard