HomeMy WebLinkAboutMortgage_Duvall"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ � FOR DEDUCTION FROM ASSESSED VALUATION
• State Fartn d3709 (R71 / 6-09)
�' f Presoibed by Departrtren� of Laal Govemment Fnance
INSTRUC710NS:
To be filed in person or 6y mail with the County Autlitor o� Counry Recorder o7 the counry where the property is located.
Filirg Dates: 1 J Real Property Must file during the year for which tha deduction is sought.
2) Mo6de / Manufauured Homes rrot assessed as Real Property Must file dunng tAe twelve (72) months �
bafo2 March 31 of each year Ihe deduction is sought.
See reverse side 7or adtlitional instrtictions and qualfications.
MP6nnt�E�neroroonVarlbuyer-seerestn�raptiravzrsesida) ,A In n/)
�n�► ���
Ma�rhl.anerrtYP2r IM2 It�y
If rw, what Ls his I her e� share of intelest? �
If rwr�a m remid is Qdferenl than that of aPP��. mdi�ate bebw
Name of rtmrtgagea «mntract selkr /'�
(
Address of mortgagee or mntract srAer (n'mi6er and svae
Name of azsignee a mhr! owner or hdder ot mort�age
AOdress at assi9nee (number aM strre4 �Y. �te. and Z
Dces ePplimm o.m pmperty in any oNer If',
munry m Ind�ena? ❑ Y2S
❑ No
Deductian app�oved in
7 C'onun(�ry� Auditor
6ddpy Recorder
_�� � w ^ e� � Recortf num r P �.
�j V a
dness unpaid as of Mongage / Con;rxt cidebteCr�s �mpaiE as of Is Ihe eppaant Ne sale
^ aate oi aOP�� �egal or equitade ovmef?
J ❑ Yes ❑ No
If mmeE vriN someorre other Ihan spwse, hdimte wlth whom
Is Ne ProDenY in Questim: MnuaDy AtisrsseE
� Real Pmperty ❑ Mnuallyl�ssessed
o'! 00°I
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r wrte
Card NO. .... ........ _
20 _ I 20 � I 20 � 20 _ I 20
Eeen �eQueste0 m P�W�Y
C-I Yes ❑ No
20 � 2(1
Signature N Counry Autlimr I Counry I Date (rtpnM. day, yea�
I I We certify under the penalry o( perjury that the above and (oregoing infortnalion is We and wrtect arW ihat the applinnl is a resident of Indiana arM
owner 1 contracl buyer of the aforemerrtiwted property on da[e application is filed.
ent add`es of app47ant (wmber antl sbec4 aN ��e, aM ZlP au
utho�aeE Gy duty esecuted Pw�er ol Attorney w by IC G7.1-12-0.7
of authw'ved persai (number arM sbeet, ci(y, state, eM LP mtle)
Date (monN, day,