HomeMy WebLinkAboutMortgage_Market (3)—"^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun1
; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn G3709 (R17 / 6-09)
�' ` P�esaibed 6y Department of L.oml Govemmenl Fnarxe
�«.
�STRUCTIONS:
To be filed in person w by mail wiN fhe Counry AutlROr orCounry Recader o/ Ne counry whem the property is kcated.
Fiiirg Dates: 7) Real Property: Must fde durirg the year (or which the deduction is sought.
2) Mo6de / Manufactured Homes rat assessed as Real Prsiperly Must file dunng the fweNe (12) months
befo2 March 31 ot each year the deduction is srought.
See reverse side /or addiWnal instnictions arM qualificafions.
Appfirant (owner orcqrtqrl buye� - see re�Mdons m rev� sitle) . n�-. R fl �
m. what ¢ his l her nxatl share ot infeiesl?
If name m fecdd a 6Reren[ Nan ihat of aPW�^�• ��te Cebr.
Name of rtiorigagee a contract
Address oi mmgagee w contraG
ownerorhdderoFrtprtgage
of assignee (number eM stree[, c
uoes aPPupm own
munty in Ind'¢na?
Recortl number
- .F�V - Vd I 1
trdebted�ress unpaid as W MMga9e / CanbaU cHnMetl�ress �mCaiG a d
v __ dateo(appGmtion
stafi, antl
anyother .DI�$j}'e1• i\r / l a?
�. . ��
Yes ........... —
' �Q�T /^^ ^/ _
D�uction aPW�'d in ihe amount oF. � v . O• • • • • • ! . , ' ' • " -
� �'v�/�.00 •• -
Zp _ Zp � _ _ 20
Year
CaLay�AUaiwr
Yes LI No
� tl�e MoPertY � Vuestian: MnuaOy Assessed
❑ RealROpenv ❑ Mn�alNAssessed
Has ihis deEuction Eeen
for arrent yeaY?
20
Date (rtnnlh. daY. )°a�
m o�Y
❑ No
r�
I/ We certify urWer the penalry of perjury that Ne above aM foregoing intortnaGOn is true and correct arid ihat Ne applicant is a resident of IMiana aM
qmer I contract buyer of the aforementioned property wi date appliption is 51ed.
tlty; state.
person (num6eraM SbeeL mR sbte. and Z/P oode)
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