HomeMy WebLinkAboutMortgage_Meny (7)�`� STATEMENT OF MORTGAGE OR CONTRACT�INDEBTEDNESS r sh vear
ry s FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 93709 (Rtt / 6-09)
S I Presaibed 6y DepartmeM ot Loral Govemment Firence
wsrRUCnoNS:
DEC ��e
b 6e filed in person a by mail with the CountyAuditof or Counry RecoNer o/ the county where the properry is located. C. F�����
Filirg Dates: 7) Real Pmperty: Must �le dunng the yrearlor which the deduclion is sough[. p,�d�y�
2) Mobile / Manufactu2d Homes not assessed as Real Property: A1ust file dunng [he tweNe (12J months p�TOR
6efore March 37 of each yearthe deduction is soughG � G�BSON O N Y l�nryRemrder
See reverse side /or additional insWCfions antl qualificatbns. �
App&ant( arwnt2r16uyer-se�e-/�esI�\1p.{p��/op� reverseside) -�
/7 M � i i �-F- / l 1 /A !1 . ) � iY7 �i •
ns� rawe ca real popertv as a - MMgage � convaa
��fd� 1. �vmV year MerCh 1, artent yP:.
(/ / 7�i'G�
If no. what Is his / her e�ct share of interesfl
If name on re�wd is difierent �han Nat of aPPlkanf, irMiqte �elow
Nartre of mongagee or mnVact seuer
Address d mortgagee «wntract se�er (number end sbee; cily, sta:e,
Name of asskyiee w otha! ovmer or halder of rtprtgage
Adtlress o( assignee (number antl svee4 �y, s(a[e, aM ZIP cotle)
�
applipnt axn propeny in any oNer
ly in Ind'ana? r
❑ Yes i
i approved'c� ttre amoun[ of:
20 20 _
3Me W CamtyAUtlimr
Ws.
�
RemN nurnbu•
a
rc owreE wiM someore aher than svw+m.
numCer
Y� u No
property in puesnon: MnuaAy Assessed
�� P�oaenr ❑ nn�uaPi wssessea
� „��,y r3�uoa-�� rz
m�� 5
COUNTY '� I ( — � � � �
20 � i
I Cou"0'
2q
D2�e (monfh. daY. 3��
� P�Y
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I/ We ceNfy uMer ihe penalry of perjury that lhe above and foregoing infomialion is true and correU and iha[ ihe applinnt is a resident of IMiana arW
owner I mntract buyer of Ne afwementioned pmperty on date applicabon is filed.
e/s tW reme) � Dare ( daY• Yee�
!�_ "i1__ i � /� 9�� _ _ � / �`m'�� _ / /
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Gy EWy ezecutetl
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persm (numbcr aM sbee( cRy. state. aM ZIP wde)