HomeMy WebLinkAboutMortgage_Tenbarge"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
,�_ ; FOR DEDUCTION FROM ASSESSED VALUATION
. . State Fwm A3709 (R71 / 609)
•S f Presaibed by �epanmertl of Laal GovemmeM Fnance
e
wsrRUCnoNS U �gry� w�
To 6e filed in person or by mail wiN the CountyAUditw o� Counry Recnrder o1 the county wheie [he poperty is located. r� C U�9
FiNrg Dates: 7) Real Property: Must file durrrg the }rear hr which ffie deduc6on is sought. � Counry Auditor
2J Mobde / Manufactured Homes iiot assessed as Real Property Must �ile dunng the rv+elve (12) monfhs
before March 31 of each year the ded�ction is sought a - nty Recorder
See reverse side !ur additional insfructions and qualifications.
/��i �OM11Cf 0( Wllff2fl bUyCf'� 25ilICGJlLS Q/I I�fYEISB SY�2� . �
- 3/- y80 -Oo
Ipaftl� 1. Ment yar ( Mardi 1. airtenl
u
li M. Wh2� 6 h15 / h¢! 2%dQ Sh2I8 Of VINJESt?
It name on �emN is drtterent Nan that of app6can; iMifate Eebw.
Name oi nwrtgagea or contract seller �/�
Address U rtartga9ee or contract seAer (number a sbee; ciry, sfate, aM i
Name af assignee or other ovmer or hdder ot mortgage
AEdress of assynee (number aM stree4 �1: �. antl ZIP cotle)
Does epplifaN own property in any oNU If yes, what count�/1
munry in IMana?
❑ Yes ❑ No
20 I 20 I 20 I 20
���
RemrG numbei Ppe num6er
a. (o -O � O 9 �O «�
�( Mortga9e / ConSad iridehtedness unpaiE a of Is Ne applirant the sole
Eate o( ePP��� legal w equitade ovmM
n Yes ❑ No
Is Ne property in quesfion: Mnualy Assessed
`7 Real Roperty ❑ Mnually Assessed
p" 0.fobile Hortie (IC 61.
w„a,T� llrawer \'0.�..G.�.?.-:.... ,�
_ �l✓ ]n
1UDR01 C�7I�C� �0. .�R..�.�.f.l........ —
� ' _. —
1/ We certify un�f;r the penalty of perju�that the ahove and foregoing information is We and mrteci aM that �he applirant is a resident of IrMiana aM
owner / mntrac� Cuyer of the aforeme ed property on date applicalion is filed.
� (owne tull neme) Date (month, day, yea�
�� :. ,, ,��.�.,� �
A ' t a0tlress of a�G nt�umDer and stree4 � e, aM P e)
oas S ,(I ��63
rmn autlnmed Cy 0uly execu:ed Power olAtmrneY or by IC 61.1-12-0.7 Date (rtronM. day, yea�
�tlress of autharzed person (number antl sbeef, dty, stdfe, and LPaotle) .
'/