HomeMy WebLinkAboutMortgage_Grubb"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 03709 (R71 / 6-09)
�' � Presmbed by Departmen� of Local Govemmenl Frence
� "e Mark
�vsrRUCnoNS:
F fJed '
To 6e filed in person of by mail wiN the CounryAUditor or Counry Recorde� of the counry whele the properry is locat
F76g Dates: 1) Real Property: Must file durirg the year for which the deductlon is so�ghf. un Eimr
2) Mo6de / Manufactured Homes rrot assessed as Real Property: Must file dunng the hveHe (72) months I—'1
6e(ore March 31 0/ each year the deduGion is sought. � N fLb �W)ry Recorder
�J I C
See 2verse side for adtlifional instn�ctions antl nu�lficafions. � �
Aoo5ra ! r arcantrad buwr see mslnUnrts rse sdel . n/ �h`�-�1�
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otinterest?
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Name W rtangagee « mntrarl seller
r I legal eesaiPOm " ' �dtMdiil�rl Y q �
- a3_ -aoo-oo/. 8 30- oa o!! 5�3 �'
�9a9e 1 Contraa in0ebtetlness unpaid as U Mortgage / Cmtract iMebtedness unPZid as d Is Me ePP�I Me sole
Marrl� 1, cu`�-n�t yP.ar Ea[e of aDP�� ��� w�N�ae �eN
-/ � Q �� ❑ Yes ❑ No
If wmed with someo�re dher Nan spouse. iMkate wtlh whom
Atltlress W rtartgag� ar mntrad se�er (numher and street, a
Name of assignee w oNer owner or MWer of mortgage
Address ot� aM street cGy. sfare. and ZIP a
t,a
Ooes applimnl avm pmp in any oNe If yns,
munry in Inde�u?
Yes ❑ No
Deduction appmved in fha amounl of:
zo _ � zo _ � zo
sy�wre w c�cy a,a��
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state, aM ZIP cade)
�12� Td�ll9 �4iI1Ci�
COUNTYAUOROR
zo _ zo _
Is ihe property in Question: Mnually AssesseE
❑ Rea� aovertr ❑ a,nua�yassessea
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Dra�ver N . ......
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I I We certity under Ne penalry of per�(y that the a� aM fwegoing intomiation is W e and cortect aM that Me aDW�t is a resident of Indiana and
owner I contract buyer of the atoremerrooned prope on date applicatlon is fileA.
sglnamRf�' wne—rs hID rmme) �n � � o-ate (month. dar, yaa�
�`3�/�L2art TY •
Fu0 resiAem adOress ot appGCan ( wmAer e CsUeet. � te, a� LP oo0e� (�� �, �` � .. ,
�a�d f- �ceSl � n 4��s.�v�
Person authonzed Gy GWy esewted Pov.er of Y w by IC Gt.t-12-0.7 Date (mon(�. day, yea�
Mtlr�s of author¢ed pe,sm (number aM s�ee; tlry, state, and LP oode)