HomeMy WebLinkAboutMortgage_Long (5)"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year (
_ = FOR DEDUCTION FROM ASSESSED VALUATION �
�• Stata Fortn G3709 (R71 / 6-09)
� Presaibed by Departrrierd af Lod GovemmeM Fu�amx
�«.
File Mark
INSTRUCTiONS:
To be fded in person w by mail with the CounryAWitor or Counry Recorder of the counry wl�ere the poperry is tedj F�� ��
Fifig Dates: 1J Real Properry: Must file during the year (o� which the deduction is soughL Aud'ROr
2) Mobile /Manufddmed Homes rat assessed as Real Property Must fi/e dunig the M1vefve (12J monfhs
6efore MarcA 31 of each year Ne deduction is sovghG JA N Counry Remr�du
See reverse side lor addi na � structbns andqualificafirnis.
1, nrre�h yeer
�,�
Key rvmCer
of IMortuage /
Memh 7, p
of mortgagee a contrari seAer
Pddrea of martgagee «contraG se�er (mmbe� and stree4 �l: sta'e.
Name of assignee or other ownet or ha1tlG of �-' - /
AdEress ot assynee (num;
�' �\��S�W o�C\�.......,.
_ �, �`` C� � f�\ _��• ' .
� L1
ora� `O .
�
C�� �
2� _ �
I/ we certify urWer the penalry of
ovmer I co cc buyer of t e atw
Sig�ture (ovme name) f
b
ull reside�rt adEress W appfcant umDe
'o l0 75 / S,.
Peiwn autlnraeE Cy didy ezecuceC Pow
[he above and fc
property on date
person (numbere�M sheet, ci(y, sfate. antl Z(P cade)
�_ol0��i-�d�. Q V'�Q�� �' Il gaRe CJ�O �
ness unPaid as of Mwtgage / Contral] mGebtedness imD� as d Is Ne aP�t tl�a sde
/� date of application legal w equNatle am71
VO� ❑ Yes ❑ No
tt awnetl with someone oiher ihan spouse. mdxate wiN whan
is the property in puestion: MnueDy Assessed
, ❑ RPaI Property Q /vmually Assessed . . _
ta
111�llL•L'7
r�
zo zo _ zo _ zo
ca,mr oa�e c�mrn, ear rean _/�—�/
/J
ig infortnation is We and cortect arM Nat the appiirant is a resident ot IMiana and
ation is filed.
te (monfh. daY Y��)
oi /i_?I��i
� %iV . y763�