HomeMy WebLinkAboutMortgage_Eubanks (2)"•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_„ = FOR DEDUCTION FROM ASSESSED VALUATION
• Stdta Fom.1 d3709 (R71 / 6-09)
S w f Presaibetl Ey OepaRment o1 Local Govemment Fviance
File Mark
INSTRUCTIONS:
Fwm t�ed with:
To be filed in person or 6y mail with the CounryAuditor or Counry Recorder of Ne county whe2 (Ae property is bcated.
Fi/irg Dates: 7) Real Properry: Must file dunng the year fw wAich the deduction is mught � Counry Audiiw
2) Mo6Re / Manu/adu2d Homes rat asseued as Real Pmperty Must file dunng the tweNe (12) months
belore March 31 of eacA year the deduction is sought ❑ Counry Remrder
See reverse side 7w addilional instruclions arM qualficafions.
AppGfant ( oroontrqqbuyer - eoa restricp6y3 m reyerse siCe) /,
— w �tiuc- —i T—
Pssesse0 rahie o( real P�P�Y az W �C9a9e / Contract "v
Ma�di 1, arreltl year Memh 1, wrtem year
�
tt no. what a ha / her e�od share ol intuest?
tt name m remN e tliRerent ihan Ihat o( aPp6ranL �ditate below.
��'u -'r - -'-v `'''i � 3 '
2� _
I I We ceRil
ame� � co�
ar contrad SeAer (numher end stree4 �Y. .sbte.
qvmer or no ' er or rtgage
� o
(numbererrl5bee;rdy,staf dLPWCe)
rcoperey in any oUier It yes, whx
0
-ooa. �-�a
�ess unp3id az of Mwiga9e I ConYacT
date o( appG�tion
Wtat Ta�dng DiSViaT
COUNTYAUDROR
�n �
2',oQ`�.. , ..
Di•a���cr 1�..........
4 �� a.....
C�l.d \Q . ..... .. ......
Fu(I reSiEeM natltlr, ___. =.n sUeef. dry, slate. and ZIP mtle)
��'7 � i'nr/CO2D (irL PI
Psson autlroraed Gy duiy ezecuted Power ol Attaney or by IC G7.1-12-0.7
Pddress of authamed person (numDer arM sneet �1: �te, and ZIP code)
F;,:
unpaitl
Yes L1 No
�Is e Oroperty in a�estlw+: MnuaM Assessed
Real Property ❑ Mnually Assessed
Has Na deduaim been reQu�teE m proputy
for cuf2nt yeaR �_. �
�— � �—
vnry I Date (monlh. daY. 3aa�
�n is We and correct arM Nat the applirant is a resident af IrWiana arW
,.
Date (monN, tlaY• ri"aA