HomeMy WebLinkAboutMortgage_Gogel^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
•_—.. • Slate Fortn G3709 (R11 / fr09) � g 4 �
S,�,� Presaibetl by DePaRmeM of Local GovemmeM Fu�ance A B
� jU File Mark
�lSTRUCTIONS:
Fomi Ned with:
To 6e fAed in person or by mail with the CountyAuditor or Counry Recorder ot fhe counry wh�th�rop��� located.
Fdiny Dates: i) Real Properry: Must file durirg the }rear fir which the deducLOn is sought.� � County Audrtor
2) MobRe / Manufactured Homes not assessed as Real Property Must file durinq the ty�9Ere(72) months
before March 31 0( each year the deduction is sought C. �. n�°'-i''/� "'\ County Recorder
Seereversesidefor�lifionalinstruUbnsarMqyalifications. � v_ ��T�Q
vehie U mrl P�Y as d
aamnt Year
If �w. what Is his / her e� share of ii
If tNm2 on remd it 6ff2Rnt tlun N2
Name oi mortgagee or mntraa se�er
Addtass of r�a9� a mntraU sr�
Name of assignee w other owner or Y
/legal
a�rre�rt yenr
of appGrant, uWin� Gebw.
sbte. aM LP code)
Atldress ot assignee (num6er aM stree4 ctiy. slate, and Z/P code)
Oces applimnt axn praperty in any o�her It yes, what
munryin�mana? ❑ ves ❑ No
in Ihe amoum
20_ � �
UCrnmbAu6mr
�
i a W A/Mgage / ConVact uMe6tetlness imVaid az o( Is Iha ePP�� Ne sde
aate ot appGcation le9al a equitade awneY/
� ❑ Yes ❑ No
If awneO wiM snmeone othu ttan spouse. Indkate witti wlmm
Is tM P�Gert1' in Cuestion: Mmia�Y Assessed
❑ Real RoPeM ❑ ��Y �
Mobile Flartie (IC 6
Has Na deduGion Oeen feQUeSteA m proprJly
rm w�c y�n r-i .,__ n �
COUNTYAUDROR
2q _ 20 20 _ 20 _ 20 _
Counry __- .... .. I Date (month, daY Y��
I I We certify under Ne penalry of perjury that Ne above aM foregoing infortnalion is We and cortect and that Ne applinnt is a resident of IrMiana aM
owner I contracl buyer oi the afrnementioned properry on date application is filed.
»Wre owneh fiA ham Y 1 � Date (mwvh. daY. Yea�
Pefson auNOmetl oy
a�
auihorrzed persa� (num6erar�tl sbeeC dry. sbte.
Date (rtionN, da�: lea�