HomeMy WebLinkAboutMortgage_Weaver (2)-^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fortn d3709 (R71 / 6-09)
�,�,� � Presmbed by DepartmeM of Laai Govemment Fuiance
INSTRUCTIONS:
To 6e filed in person or by mail wiN the CounryAUdifor or Counry Remrder of the counry where the property is located.
FiNrrg Dates: 1J Real Property: Must file dunm,7 Ne year lor which the detluctlon is sough[.
2) Mob�ie / Manufactured Homes rrot assessed as Real Property Must fife dunng the tweNe (72) months
befoie Maich 37 0/ each year tAe deduction is srought.
See reverse side (or adtlitiona/ instnicGons and qualifirafions. �
Appfrant ( ooritra,4t buyer yjee re§Y�:liorys on reverse e , /� Za'
no. wnat
narrie m
Y rcal poperry as
Y�
than that
Name of rtrortgagee « WnVact seller
ACdres W mon�agce or mntract se0er (number ai
Name af assignee w othu owner or hdder W mort�
ALEress ot assignce (number aM stree4 mY. s�,
Does a�ipnt ovm poperty in any oNer
counry in IrWena?
❑ Yes ❑ No
DeEuclion approved in ihe amount of:
� �J — / eo—+' Q�C�C/1
� / Contraa'ude6tedn¢s unpaid a of
nurent year
� � aM ZIP code)
v�
6oyn Auditor
� � 1 �
Coun er
�9a9e / ContrarY mtlebted�ress unGaiE az d Is Ihe ePP�t tlie sda
i of aP D O� �\ �egal w equttaNe rnm�
� U ❑ Yes ❑ No
someone other ihan spouse, UMicate wRh whwn
Is PmGenY in Gurstion: MnuaDy Pssrssed
Real Property ❑ ArmuallyPSSesscd
If ye5. wdiat muni�/.+ � What Tadng D"5trk
COUNN AUDROR
D��:������- �o.a?.ao..9.-......
Card \'O. ....,�.��..�'•�........
20 20 20 20 _ 2Q _ 20 20 _
Sig�nrte U Counb Auditnr Counry oaie (month. daY. Y��1
I I We cer[ify uMer the penalry of perjury that Ne aDOVe a�W foregoing infortnation is We and cortec[ arM �hat the applicant is a resident of IrMiana arM
owner I coniract buyer ot the aforemerrtioned pmperty on date application is filed.
Sip re hyl name) Date (rtionth, day, yea�
Fu,/ll Lesitlent dress o/f�a�ppfrcant (number aM SLeef. riry, state, ard 21P cotle)
�7/���� W@(/✓t�r
Pgson auNO�rzeC Oy Outy executed Power of Attomey or Ey IC 61.1-12-0.7
P.ddress of auihor'¢ed person (numEer arM sbeet, tiry, stale, aM LP aode)
'Y