HomeMy WebLinkAboutMortgage_Dillon� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_. FOR DEDUCTION FROM ASSESSED VALUATION
• State Fotm 93709 (R71 / 6-09)
1 Presaibed Ey �epertmard al Ln�l Gavemmem Fumnce
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INSTRUCTIONS: AP �
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To be (ied in person or by mail with the CountyAUditor or Counry Recortfer o/ fhe county where the pmperty is located.
Fiifig Dates: 1) Real Properry: Must file dunrg the year fir which the deduclion is soughL n County Auditor
2) Mo6de / Manufactwed Homes not assessed az Real Properry: Must file during the M1veNe (12J months �_
6efae Ma�ch 37 0! each yenr the deduction is swghL �.,1� ^tY Recorder
See reverse side for additiunal inswalons aM qualificaUOns.
Appferaen� ormWarfbuyer-me mle sde) .
Ta ' District Key nimEel / legal desaiption RemN number Page numbef
� � - CD-QD/. (oe1! -Oo2 � �(SSCo
As�sed rapre d real P�P�Y as d Mort9age / Contrarl irdebtetlness unGaid as d Morigaqe I Conttact hWebteEness unPaid as d Is Ne aOP��t tha sale
Math 7, ar�mt year MarM 1, wrte�rt yeer � date o/ aPP�� legal w epWtada oxne(/
I � � fi (� (/ ❑ Yes ❑ No
ro. �t
nalne an
Nart�e M morig29� � rontrri se0er /l
Y
Addras ot mortga9� v mntraa seDer (n�mbe�
Name ot assignee a dher awner rn hdder of mc
bQN OMI V�D�Y V1011`� ONtt
InOiana? ❑ Yes
DeEuaon app�wed'c� the a
20
Sig�hue d Counb A�tlGimr
I/ We certify u Ni
owner / mn buyei
20 _
c�d'rate heNb�r.
s�te. aM ZIP rode)
sfefe, and ZIP cade)
If yes, wha[ oount)/?
I No
penalty of perjury
W�at Tari� Distrifl?
spouse. vw¢ate wm vmom
�Is IM m 0��� AnnueM AaesuE
PropettY Q A!vn!a0yA55essed
� u_.o� Qi�c.E G
d3-4 ss�
20 _ 20 _ 20 _ 20 _
Counb Date (rturR�. OaY. 1��
ihe above arW fomgdng informaGon is We and cortect arW Nat the applinnt is a resiCent �
property on date apPlication is filed.
ad�ess W appfreni (numDer anE sLee4 �1Y, state. and Z�acotle)
IS'N �TS w �l��/�cc�7'ow �-�v �t76>o
vved Oy dWy exeateE Pa�uM o/ AttomeY w Ey IC G7.1-12-0.7
Wq(rsed person (numGerentl sbeeG dty, sfale, arW ZlPootla) .
20
IrWiana aM