HomeMy WebLinkAboutMortgage_Welte"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
:_ • FOR DEDUCTION FROM ASSESSED VALUATION
� Spte Fortn d3709 (R71 / 6-�)
,' / Presa�betl by DepartmeM ot Laal GovemmeN Fuance
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To be filed in person w 6y mail wifh the CountyAuditw or Counry Rewrder oI fhe counry where the property is located.
Filirrg Dates: 7) Real Pmperty: Must file durirg the year lor which [he deduction is sought. Coun uditor
2) Mobite / Manufactured Homes rrot assessed as Real PropeRy Must file dunng the fwefve �72) months
before March 37 of each year the deduction is sought. \,���y
See reverse side /or additional instmcfions and qualilrcations. UN �
Apo��car+t �merorcaieartbuyer-seere _ onryversevde), . r_1BS
� � PoP�Y az
Y�
Itp, wh3t 6 hi5 ! IR! ¢X2R Sh2R Of I(IICf¢Si?
wrmnt year
If name on femd a Eiflerent than that o( aPP��t �ditate Oelmr.
Name of rtnrtgagee m m�trarl seAer
Address of mort9a9ee ar
6nnc own property in any oNer
Ind'ena? ❑ Yes
o��� � m me �m oe
sni ana sqeq4 crt�: state.
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morigage
slate. antl LP catle)
11 y�. what m
I No
Record number Page num
O/. �O � Q�' po
i as af Mortgage I Cantratl inEebteEness unpaid as of Is Ne appGran the sole
Eate oi aOP��� legal a eWnable owne�?
❑ Yes ❑ No
If rnmed wiM somearre oUrer Ihan spouse. iMicate witti whom
Is Ihe praperty in QuesOOn: MnuaP/ AsSesuC
1 / ❑ Real ProPertY ❑ �le Home�flC d61.1-i
�hk deductim Eeen repuested m p(opaty
unnrv r^^—
❑ Yes ❑ No
D���„���� �o...a:��.......
ZO 20 29 _ �
Card NO. ...����...........
Si9raMe U CamfY Autlimr N. OaY. Y��)
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1/ We cerVfy uMer Ne penalry of perjury that Ihe above anE fore �_.. ._ ___ ....,..,... � e.. a��u u�at me applirant is a resident of IrMiana arW
owner / mntract buyer of ihe aforemerrtioned property on date ap0��qon is filed.
SioruLire (o�me/s hAl name) „ Date (montli. daY. Y��
� I FWI resitlent address of aDP��nt (rfumber aM shcef, tlry,
iau_>y s i2ose�a�
� Person authoraeG Oy duty esecuted Power o(Attomey m
person (number aiM sbaet, tity, sYdfe, aM ZIP cotle)
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