HomeMy WebLinkAboutMortgage_Coleman (6)�
�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year ,
FOR DEDUCTION FROM ASSESSED VALUATION
• SFate Fwm C3709 (R71 / 6O9)
� � Presmbed q' DePa�N ol Loral Gwemmerd Fu�ance
INSTRUCTIONS:
b 6e (ded in person or by mail with the County Aud¢or w Counry Recorder o/ fAe rounry where the property� t� F �
Frfig Dates: 1) Real Properry: Must file durirg the year (or which the deduction is sought. � Counry Auditw
2) Mobile / Manulactured Homas rat assessed as Real Properly: Must fiie dunng the AveNe (12) month,sU G q�Q �flWnty Remrder
before Ma/ch 37 of each year Ne deduction is saghL A t
See 2verse side /or addit"qnal inst/uUians and qualifications.
Appfrenl or mntraG 6uyer see rerse siie) .Q ywa.
A�. �- ,�a, �QQ,m n�� � ' o --- -
Ymalp'opertym
Y�
m
Name of rtnrtgagee ar mntrarl se0er
ACdr�s ot rtn�tjagce v mntrad
Oces appli�ra wm praperty in any oNg
munry m IrWiana? ❑ Yes
`;,�
��
n�o- - `t�- vo,- �
A/ortgage / Cantraa 4de61edness i
Mamh 1. arteirt year
est'/
aCP�^�• hMipm Ceb�r.
l �`
�(unbr� and streeG �l: slate. aM LP cade)
9rof mortgage
�; sfeM. antl LP code)
�_ i �
). o� - u oc v
1 as U Mort9a9e I Contraa mdebfeEr�ss un7� as of
date oi a0piptim � 0�, O��-S1
�� v
rc avn,ed witl, mmeane atlrer than spa,se. rtdipte wirt, �
�
v�; u No
�15-�t(pe property in QueSion: MnuaUY A4e55e0
y(J Real P'oPertY � ArmuallyASSessed
..._. ......y
t �1� ....
DC�\\'Cl' 1�.........'• •
couNrr nuorrort
3�0�.....
ca��a �o. ...........
za— � 1���.�
Counry
�,�a,, aar.,�a
I/ We certity under the penalty oi perjury Nat the above arW foregoing infwmalion is we and cortea arid that the applicant is a resiCent of Indiana arcl
owner I contraG buyer of the atoremerrooned property on date appiication is filed.
,,,�nim �nunc.t n,emnre� _ Date (mmrh, daY.Y�)
iM sfree `til��, sfele. antl LP oode)
n
AAtlress af aWwrrsed pusan (numbera�d SLeeL �1: sbte. aM LP mde)