HomeMy WebLinkAboutMortgage_BirchSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
� FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn d3709 (R11 / 6-09)
` Presaibed by Deparimerd o1 Laal Gavemment Fiwica
i e Mark
INSTRUCTIONS: � CCo
b be fJed in person w by mail with the CountyAuditw or Counry Recorder of the county where the pmperty is rocar�U 1 Fo d wim:
Fi!'mg Dates: 7) Real Property: Must file dunrg the yaar lor which the deduclion is sought County Aud'rtor
2j Mobile /Manufact�red hbmes rat essessed as Real Property Must file during the hveNe (12) mc�ttry§,
6efore March 37 0/ eacA year the deduction is soughG County Remder
See �everse side !or addirional instnictions and qualifications. NTY AUDITO
Mo�nt (owrerorcontraU buyer- see ms4icbo� on reversb�tide)
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tl funre m �eard is dEferent Nan Ihat af appBmN, rtd'wate hebw:
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of m^ngargm p� seue' /� J�— y
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,i.wl.�iv:�•• — (�� r
ss mor[gagee a contraU setler (numbrl and strae4 �'. sfale. arN [
or assignee «atml ownn w haidu of mmgage
saf (numberandsbe�e q%p' sfale.andZlPCOde�
i �n�CJ V �C�(i�
3ppli�anl _ propeJty in any oNU If yes. wh2l countyt
2� � 20
Sigfanae ot,Camb aiattor
G • %• %�'^-OY`-r�n�
1/ We certify urdrl Ne penalry o -ury thal
owner I contracl buyer ot the atoremerrtioned
sa^amg law}en �1m^�1 — i
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legal or epuila6le owne(!
❑ Yes ❑ No
i001158. �IH:ICBiE K�(h �'AIOT
is the 7�PenY in Ou�tim: MnueDY Pssesse0
❑ Real P`oPerlY Q �irtivally Assessed
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Card \O. ....�•��.......
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ve arW foregoing intwmation is We and cortect arW that the applicant is a resideni of Indiana and
rty on date appliwtion is fileE.
53� S, P,�nevi'ew Or . Pi,n«iOn. TN '�7,
Pe�wn auUpmeO DydWy ezeWCed PoweralAftomey w Cy IC 67.1-12-0.7
AdE2ss d aW�or'ved Oersm (number an0 strce; dty, s7afe, end LP code) .
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