HomeMy WebLinkAboutMortgage_Dunn (3)^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T hi Year
s. -
• FOR DEDUCTION FROM ASSESSED VALUATION
• Stale form d3709 (R77 / 6-09)
�` � Prgaibed by �epartrtrent of Lusl Govemrtrent Frence
� a
�srnucnoNS:
To be filed in person a by mail wifh the CounryAuditor or Counry Recorder o/ the couniy where the property is located. C�
Fitirg Dates: 7) Real Property: Must file durirg Me year fof which the deduction is soughL Co A�imr
2) Mo6�7e / Manulactured Homes rat assessed as Real Pmperty Must fi!e dunng the Iwelve (12) m��ON OU Y AU U
befora March 31 0! each year fhe deduclion is sayht Counry Recorder
See reverse side !or addifional insfrucfions and qualifiwtions.
Key rvanher / legal
1 rWUe d real P�P�Y ��
arRlri yeN
h's ! her esaG share of interestt
If name on mmd 6
Name of rtiortgagm ar contraa
Name
-�
Alo tgr age � contraa u,eebcea�ress
Ma�d� 1, artent year
mntraG seAer (numbel and sUee; cdy, stale, aM ZIP oo0ej
Iwlaer o1 mortgage
AAdress of assigrree (number antl sbee4 �Y, state.
Oces applrcam w.n pfoputy in any oNer
munry in InOiana? ❑ Yes ❑ No
' . \P/� ✓_oC— �U
D�uction apqoved'u� �ha amount ot
20 _ 20 _
sy�a,re a camb nwrtor
4 O� Retoid numCU Page num6er
O O
id as of Mongage / ContraG uWebtetlness �mpaid as o1 k: �he appfmant ihe sde
Eate M app�mlirn legal w e0���de mvrM
❑ Yes ❑ No
If owned wiM sameone other Ihan spouse, i�iqte wNh whan
Irs �tl�ie Pro�perry in GuesUOn: MnuaM hcsessed
qc� �PeKY ❑ FVmually Assessed
Duu� �u�-1 0
ia -a �.�o
If yes. what munpR I VJhat i.
COUNTYAUDROR
20 _ 20 _ 20
ry
❑ Yes ❑ No
20 _ 20 _
Dete (monfh. tlaY. 5'�� .—
I I We certify urWer Ne penalry of perjury Nat [he ahove and foregning infortnalion is We and cortec[ arM tha[ ihe applitant is a resident of Indiana ard
ovmer I wntracl buyer of the aforementioned property on date appiicatlon is filed.
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FWI resldent eEtlress ot aPW��� (numDe� �
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Pr�son auNOrired Oy Cuty esecvretl Power
oi auumraed person
riry, st1ate, and Z–ITP a�otle)
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oa�e c�,r�.