HomeMy WebLinkAboutMortgage_Scott"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
= FOR DEDUCTION FROM ASSESSED VALUATION
� Stace Fortn C3709 (R71 / 6-09)
� w. � Presrnbetl by Departrre�rt d Local GoremmeM Frence _�
File Mark
INSTRUCT70NS:
To be filed in person or by mail wiM Ne CounfyAuditw or Counry RecnNer o/ the counry wl�ere the pioperty is bcated.
Fi/rrrg Dates: 1) Real Properry: M�st hle dunrg Me year for which fhe deduction is soughG
2) Mo6de / Manulactumd Homes rrot assessed es Real Property Must file dunng the fweNe (12) monfhs
be/ae Maich 31 0/ eech year the deduction is �ht.
See �eversa side for addilional inshucUOns and qualifications.
o ncanfraGbuyer-aeercs4i'�qmrewrm..tlQO) . �
�,�d�,�,��
1, qnent xar
rc m. whaf ts his � hei erari snare of IntrJasn
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,e � �,� ��� ��� � �
. a�rterit year Eace Of aDP��
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If owned wiN somearie other ihan
m RmN a df.feRnt Man tllat ol appCfaN, rt�Aitlte Debw:
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trty. sbte. eM ZIP code)
Name of assi�Fee a oltw orner
(nvMVaM abeet �Y. ��. an0 LP mde)
Counry Auditor
aio ��
: un7aid as d Ls Ihe eGP�t Ihe sak
1eg21 a eQURade owne(./
� ❑ Yes ❑ No
hdkate �wiC� wlwm
Is tlre 7�VQNY in Quesaon: MnuaOy AsSesseE
�"rtea� a�oaenv ❑ !w,uaiN as�
� eoN�ro... —'� ' �� I W�at Tadrg D'strirl? I for w�rent yeaR Deen reGUeSteC on piapvty
_ � � ❑ Yes ❑ No
�O/�, ,,, OUNTYAUDROR
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n y 5� `......... Zo_ �_ �_ �
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Sgnahn ___..,..w�mr Caunry Date(moN7i.day,Yea�
I I We certty urWer tha penalty of perjury that Ne above aM foregoing infwmalion is We and cortect arM Nat Ne applirant is a resident of Indiana aM
owner! contract buyer of the aforementioned property on date applicatlon is filed.
�9 (uwnBrs MI nemBl i. . i Date (nnnM. daY. Y��
fiI _,z3�zs ��rfa �>� �
Psson auNOnsd Oy duty ereated Pawer o( Att�y w Cy
ACCress of authorrzrL person (num6eralM stree; ri(y, stafe,