HomeMy WebLinkAboutMortgage_Like�a �3
"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
• Slate Form A3709 (R71 / 6-09)
�,,,, � Presaibetl �y �epartment of Lxal GovemmeM F�unce
File Mark
INSTRUCTIONS:
hied wiN:
To be filed in person w by mail with the CountyAuditw or Counry RecoNer o/ the county where the property is located�
Fil"mg Dates: 7) Real Pmperty: Must file dunng Me year /or which fhe deduction is soughG ��_,�,��
2J Mo6ile / Manufactured Homes rat assessed as Real Properly Must �le d�nng the tweNe (72) month �- "11
before March 37 of each year fhe deduclion is sought. ����
Sea ieverse side for addiLOnal instn�ctions and qualificatrons.
A7PGaM (owner or b+ryer - see restn'ctions oq�vzrse sde)
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ng Qistrict _ Key rumber / legal desaipUm Retord P rwmCef
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o- OD.98 � s '� a�
e/ Contraa intlebtedness unpaid az ot Mortgage / Contrary intleMetlness unpaiE as of Is Ne
date of appGCation legal w epuitable owre/t
❑ Yes ❑ No
If w'rce0 witli 5omeone dhet tl�an 5pous8. indifate wifh xMrn
than lhaf of aPP��4 ��te bebw
Name of mwt�a9ee a contrect sMer
Atldress W mongagee m cantraU se�er (number and
--'---"..-•+�•_, mmer or.hdder W mortaa
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ee( cdy, sfa[e, arM ZIP tode)
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4Vha� Ta�dng 0¢Irif1?
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6 property in Qunstion: MnuaAy Assessed
Real PmPeNY � %+�^��Y%��
MoWle Fiatie fIC 6
Mas Ni5 tleCUUbn Eeen rtquesled m pmpelty
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SignaMe W CountY Aueitw I Caunry I Date (month. daY Y��
I/ We certify under ihe penalty of perjury Uat Ue above and toregoing iniortnation is W e and cortect arM ihat Ne applirant is a resident ot IrWiana and
owner I mntrad buyer of �he aforementbned propeM1y on date appiicalion is filed.
' ra (owire/s (� reme) Date (�ronM. daY. yea�
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Person auUqr¢eC Ey Cuy executed Power o( Attaney m by IC 61.1-12-0.7 Da (mmN, day, yea�
Address of aWror'¢ed person (number arM street ri1y. stare, and ZlPcade) .