HomeMy WebLinkAboutMortgage_Heusmann^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co Ylown ar
_ FOR DEDUCTION FROM ASSESSED VALUATION
: . .. � Stata Farm A3709 (R77 / 609)
S,.» 1 Presaibed by �epartmenl of Laal Govemment Finance
wsrRUCnoNS: �e a�` 2010
To be filed in persan or by mail with !he CountyAuditor or Counry Recorder o/ the county where tAe properry is located. F� �� ��
FiNng Dates: 1) Real Pmparty: Musf file dunng the year /or which the deduction is soughL � f�uetv quditor
2) Mo6de / Manufacfured Homes rwt assessed as Real Property: Must file during the M�eNe (72) months N ��°""
be(ora March 31 ot each year the deductiun is soughG Cou�Remrder
See reverse side (nr add'Rionaf instructnns end qualificafions.
GIBS IT R
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7ab District " Key numDer I kgal des�
edraWedreal7oP�Yasd Mortaage/i
Marth 1, amem year Mamh 1, ai
If ro. what Is Itis! her e�G share of intrlest?
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- yoo - Do�• l 9S- o a I�oi
iMebteCness unpaitl as o( dMart9 �ge �� mEebteCness unVaid as d
5 n0�
Addrea of rtnrtgagee w mntraa se0er (nuMer aM streeG cdy, sta�. arM
Name of asvgnee w othnl rnmer or twlder of fmi9age
Atlarass ot assi9nce (numGer aM street, tl1y. slafe,
Does e�imnt axn yopeM1y in any
��h �� ima�, � . _
DeCU�tian appmved In Ne amount of:
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m
yes.whatcount�t
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If ovmetl wiih someone other ihan spouse, Indimte with whom
WtatTad`g
numDer
3ppOrant Ne mle
r epuitade mmeR
❑ Yes ❑ No
Is ihe property in 7uestion: Mm�aM Assessed
❑ Real Properry ❑ ArmuallyAssessed
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D�•ativc►• i\'O.
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JUNTYAUDROR C,'jl•� 1��0. .. �L 7I , -
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Sigrehue— o�f Ca^umY`AuAditc'r' � �� I Caunry I Date lmwv,. ....... -.
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I/ We certi(y uMer e penalty of perjury N e a6ove and foregoing infortnalion is we and corteG and Nat the applipnt is a resident of Indiana arM
owner I contracl 6uyer Ne afaemefrtion property on date applipibn is filed.
Sig � (o ' � � Dare (monfi. daY. Y��)
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Fiill en da t(nmDerand tiry,slate, ZIP )
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Person auttnmed Ey duty ezecuted Power of Attorney or by IC 61.1-12-0. Date (monN, Oay, yea�
P4dress ot aWmr'v� person (numberaritl sbee; tiry, state. arM LP code) ,