HomeMy WebLinkAboutMortgage_Tenbarge (12)'°r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Fortn G3709 (R71 / 609)
�,,,� � Prewibetl N' �rtl of tn�al Govermierd Flnance
ie a
wsrRUCnoNS:
b be filed in person or by mail wifh the CounryAUditor w Counry Recorder o! Ihe county whe2 the property is bcated. F
FiMg Dates: 1) Real Property: Must file durirg the year /or which the deduction is soughl. � Counry Auditor
2) Mobde / Manufactured Homes not assessed as Real Property Must fiie dunrrg the fwelve (12J months
before Maich 37 0/ ach year tl�e deduction is swghL �a tr��rtler
See rev rse side for additional in i
MW (or+reiormuroaeb - ) �
'�°�° '��' �= OD - D. 5/8 a �� P w�
ralue d real p(aperty as ot ge/ Cantract' btetlness unpaid as W A/ortgage / ConraG triCebteMess unpaid as d Is Ne app&anl the sde
1. arfcrt yeN 1, airtent date of aPP��� legal or epuitada mmeR
❑ Yes ❑ No
tt ro, wfial is his I trer erad shara of inferast't It ovma0 wkh someone Wher fhan spause, uMicate wtth whom
'/ rwrie on remrd is QA1umt Nan Mat of aOP��L mdimta EebMC Is the p'operty in Question: MnuaAy Assesud
❑ Real ProPeAY ❑ MnuallY Assessed
Abble Fiome C G7.1-
Name af rrortgagee or mntrad sWer
Pddrea of mor09a9� w contract srder (num6e� end sneet �. stata. aM LP code)
Name W assignee or oNa ovmer w halder N rt�ortgage
AdCress o1 assigiree (numbar eM street ary, slate. arW ZIP todeJ
Does e�qkant o�n WoD�Y in any aher -"'--.' _• �....^wn— ___ . What Teri�g Districl7 Has N6 deductim Oeen repurstetl on prapaty
cwnty m InOiana? � Yes C . '� - -- for wnent YeaY7 ❑ Yes
❑ No
Dra���er i\'O..C?�Q�.Q........
Deduction appioveE in the amount aE " - .
C1C(11\`�. ....R�J' � 20_
2p_ 20_ .............
�����,H�� � 15a� �qa, � ���,�,�,.�y,��
i/ We cer[ify urWer Ihe penatty af perjury that Ne a0ove arw �v��y,...7 :..._.__ _ cortect arid Mat Ne appivant is a resiCent o( IrWiana and
owner I contracl Duyer ot Ne a(orementioned pruperty on date applinbon is fileG.
h fiA remBl� Date (month. dsY. Y��
F nt a0tlr�ss W ap (numEeiand sbee4 �4: �te. � ZIP e)
f S 71�34 -
'auNOrized Cy EJy exeartetl Pwer W Anomey or Cy IC G7. -12-0.7 Date (monM. OaY. Y��
� P4Eress at authorrsed person (number end saeeL �: sbte. and LP tode) .