HomeMy WebLinkAboutMortgage_Begle"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
FOR DEDUCTION FROM ASSESSED VALUATION ✓.
� State Fortn G3709 (R71 / 6-09)
� w. P�esaibed by DePartmeN of L�1 Gwemrtrent Fnanca
'I ark
INSTRUCTIONS:
To be filed in person or by mail with the CountyAUditw or Counry Rewrder of the counry where the pioperty is located. F ��
Filirg Dates: 1) Real Pmperty: Must file dunng tfre year for which the deduction is soughL
2) Mo6Ae / ManuFactured Homes irot asseued as Real Property: Must file dunng the fweNe (12J months
6efore Malch 37 o(each yearthe deduction is sought. N� 1CM�^2'�C°^ier
1 a UIU
See reverse side for addiUOnal inshudions arM qualifpations.
wppu-em�owne�mmno-a Y -see caonsm
j- o�� � �,� k
b•
Asrssed e U2ai P�P at o( Mon
Ma2A 1. aimrt year M�
It m. what k his I her e� share of intr!¢v1
It rartie m reornd is QRerem tlun tl�at af appOw�; hd
Name ot rtnrt9a9ee or contr'aa seller
j�=400- 00�'-340 -(�� I�"ii
l
/ Contrau Vde6tetl�ss unPai7 as ot Mortgage / Cantrul iMehtedness un7� as d
a�nt yrar tlae af appfKatiui
• ! \�
someane ott�er Uun spouse.
Address of rtartgagee ar mntract seDer (number and sheaL ciry. s7ate. erN LP code)
Name of assi9nee or oNe� owner or hdder W nqrtgape _ ,
Add�ass ot assiyiee (num6er aM saee4 �- .
Ooes ePWifant ovm D�De+b in any oNU ]� 1' 111' C' C� 0...7.�0 /. O.
munry in Indana? ❑ Yes .• •.
oae�aan avw� m rhe ama,n�
20 20_
signaw�e w Camb nnairor
I/ We ce' Mer the cen;
Cal'd NO. ...Jl.o4'Cl........
�u� � 3(n'7�55D• d�
-" _ - � � �
�
iilade a�meYi
Yes ❑ No
Is C�a ProOenY in 0uestim: MnueDy AssesseC
❑ Real RoPenY � �!!�Y �
Has Na dedud'an
for Wrtent yna(.+
r ��
(,�,�m. dar. ��
� P�Y
❑ No
ri��
Ne above and foregoing infortnation is W e and cortect aM that the appiicant is a resident of IMiaria a�
property on date application is filed. � "
I?
AOdress of autlra'¢ed pason (numbera�d stree; riry, sfate, entl
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