HomeMy WebLinkAboutMortgage_Haake""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun shi Year
.y . _..
- FOR DEDUCTION FROM ASSESSED VALUATION
� Spte Fom d3709 (R71 / 6-09) .
,' w. � Presvibed Ey Departmerit of Loml GovemrtreN Frence
File Mark
INSTRUCTIONS:
To 6e (led in person or 6y mail with the CountyAuditor or Counry Recwder of the county whem the pioperty is bcated. F0f11 � U
Fifig Dates: 1 J Real P�perty Mus7 file durirg fhe year /or which the deduction rs sought Coun Auditor
2) Mobile / Manulactured Homes not essessed as Real Pmperty Musf h7e dunng the fweNe (12) months �-�j�- ry
betwe Maich 37 oieach year Ne deduclion is sought. Lh �� �� ��
SeereversesideforadditionafinstrucUonsandquelifications. Nfi1' AU61ie
AppGc�nt (pwner ar oonfraC biryer - sae re;tnrbora m rererse sile)
�n yrar
his / trer ema
If fwrie on �emtl
_�
Mottpape � co�t
Mard� 7. artenl
ani'oWirate beb�r.
Mame a m�gagce «mnr� sene, _ . ,//.t
DI'�\�'�i �i�.. °? �� � ........
Card \to. ...6..33.%.......
��uy �� i�a�� . ., � _.. __._. I .
�� Yes ❑ No
in Recortl wmbrl I P�e n yy�
.3aa-ooa. 9ao-oa � aoio �
aa iMe6tednrss unpaid as W Mongage / ContracY'v�debteCr�s unpaid as d Is Ne eppfimnt Ne
year date of appGCatan � n _ legal or equitade owr
e. arxiLPmde)
�,nyr w��r��
Yes LI No
re property in Vur..Om: Mnuaaj Assessetl
Real FvPe�b ❑ �^�Y �
rnoa� � nc s
� Y�d� �� 4/ �
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for curtent yea(.� r--� _. �
GOUNTY AUDROR
Deduction approved N Ne amount ot
20 _ 20 _ 20 20 _ 20 20 _ 20 _
$igrenrte of Camb AW iwr Counry Date (rta+vh. tlaY. l^��
'�; I/ We certify under Ne penalry of perjury that Ne above and foregoing infamatlon is We and correct and that Ne applirant is a resident of IrWiana arW
rnmer f mntraU buyer of the aforementloned property on date appliration is filed.
� SipreNre (owne/s !u0 ) Date (nmN, day, yea�
� FWI ' ent adMrss of appGrant (number anE sLeet, tlty, state, and ZIP cotle) ,
� o P Lv, i°/P/u� 7�70
Pnlsan autloraeE Gy dury executed PoWer o(AVaney or Oy IC 61.1-12-0.7 Date (monfh. day, yea�
AdEress of aW�u¢r� person (numbe� aM street �: sb1e, aiM ZIP coCe) .
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