HomeMy WebLinkAboutMortgage_Brogan�
0
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yea
N 3 FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm d3709 (R71 / 6-09)
S f PresmbeC by Oepartment o1 Lo�l Govemment Fnance
F
wsraucnoNS:
To be fiied in person or by mail wiN the CounryAUditor or Counry Recnlder o/ fhe counry where the property is located. F� �� �''
Fi7irg Dates: 1) Real Property: Must file dumg the year Por which the deduction is sought D E 2 q� � � �
� CAUnty Auditor
2) Mo6de /Manuladumd Fbmes not assessed as Real Property Must file dunng the tweNe (72J rtanNs
before March 37 o/each year the deducGOn is sought. ❑ County Recorder
l .
See reverse�e fof addifional instn,ctrons aM qualifications. s� �� ��
MW��( ormno-aa6uyer-,sqe �rewrsesiqe). . /l . - - NCO��^�TVaiIDITOR �
- � o •000.0/� O��
Assessetl rdh1e dmal as of Rbrtqage / CantraG'uqebtedneu unpaid as W MMgage / ConbaU
Marrh 1. am�nt year Marrh 7, artent yrar Eate af appfifafv�
If m. what ts ha 1 twi eraa share ot interest? tl awned wiM sameane other i
It riame m remtd 6 Q$efP11f Ihan that of aOOWant utdiUte beJOw:
Name af rtiortga9ee or contrap sNler
A�d� W rt�ortgagee or cantrad se0
Name af assignea or oNer owner w h
Does a�imnt ovm property in any othrJ
munry m Ind"ana? ❑ Y2s
Deduction approve0'v� itre amount
�e�end streef, cdy, slete, aM LP oode)
�e -� �� �_a _ib . /
slafe, and LP tode)
If yes. what munf� What Tadrg Distrki? Na
No �
COUNTYAUDROR
20 _ 20 20 _ 20 _ 2C
Sig�anne d Caunry nWacr Counry
'� 1 I We cerofy under the penalry of perjury that the above arW foregoing infortnalion is We and
owner I contract buyer of Ne aforementioned property on date appiiration is filed.
r::01
GIBSO
�� �
0
� I kgal a W�ilade awne!?
❑ Yes ❑ No
>. ird'xa` te ritti vrtiom
ProGenY in Ouestion: MnuaOy Asessetl
�I PmPertY ❑ Mn�ailYPSUSSed
repuestetl m property
Dr:]}yCl• 1�`0.
. �. �7.�.4. -. . ...
C:ll'v 1�`�. ....�`!�,b.
. �.....
fddre5s W authorrzed person (number a�M sbeet ary. sta(e. eM Z!P cade) I'
��
''' �