HomeMy WebLinkAboutMortgage_Austin"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__, = FOR DEDUCTION FROM ASSESSED VALUATION
• State Fam 03709 (R17 / 6-09)
�' ,�,� � Presaibed 6y Oepartrtrent of Loml Govemrtrenl Fu�arxe
File Mark
INSTRUCTIONS:
To be filed in person w by mail with the CountyAUdROr or Counry Remrder o/ the cnunty where !he pmperty is located. F� �� ��
Filim� Dates: 1 J Real Pmperty Musf !le durng the year for which the deduc0on is sought � Counry Auditor
2) Mobde /ManufaUUred Hortres rrot assessed as Real Property Must h7e dunng the tweNe (72J months ❑
befae March 37 0/ each year the deduction is sought Counry Recorder
See reverse side (or addifional inslfucUons and qualificafions.
Appfxam (owneror buye� � s resfi�ons m re�erse side)
�Qfb ��[ i'1 5 i)
��«���«
Memh 1, qrmn[ year
If no, what is his / her e�ct share at interes[?
on �emd
mongagee « mntra� se0er
r/legaldesaiptirn Rem�dnum6er Pape brl
��-�i- -ao�-oo . q�-oa o o a`�
Mor�qage�/ ContraC "uMehtednPSS unpaid az of Morigage I ConVaG mEebteAness unpaid as M Is Ne applifant ihe sale
Man7'Ri rtQptyay� � date o( appGca�an leqal O itade O eY?
�L.! \ . Yes No
.J �J
If ovmed vriN someone other ihan spouse, trMipte with whom
Address of rnartyagee or mntrad se0er (number ard sveet �y: state. arM ZIP code)
Nam__ _ . _ _ — . . _ _ _ - .
Mar
� Dra���erNO....�blb........
mur
Card ivo. .... �!a.Y..........
� IS3� 78�1,5�
a,arto,
Fz��
Wlat Tadrg DistriCl
e;��
Is the praperty in puestion: Mnually Assessed
❑ Real ProPertY ❑ NmualyAssessed
Mobile Fbrt�e (IC 61.
Has Nis tleCUtYim Oeen reque5tetl m ptoperiy
tor curtent yeaR f1 .._ _ I-1
20 � 2�
I I We certi(y under Ne penalry of perjury that the above aM (oregoing in(ortnation is We and cortect and Nat Ne applipnt is a resident of Indiana aM
owner / mntrac[ buyer of the afwementloned property on date application is filed.
3�t/WE� (owire/s hA/rame) //�� � Date (/m'o�nf�h. daY. Y��) '`
. \ !il �. L� {' . �1 7 I / M M .� A �iYi l /"t �� .�l . � / �/
A���._
al}; sfate, and ZIP ootle)
(�., � n. �nr v-�'1 �7(� 70
P¢rsm authorized Ey duly eseculetl Power ol Aitomey
person (number arM sbee4 �3: slafe, anE LP ootle)
Date (monN. daY• Y��l