HomeMy WebLinkAboutMortgage_Hauke^'+ STATEMENT OF MORTGAGE OR CON I D�T�� Coun 7ownship Year
� FOR DEDUCTION FROM ASSESSED VA A�
• State Form G3709 (R71 / 6-09)
�' ,�,� l Preuri6ed by DepartmeM of Local Govemrtrent Fnance JUN 2 File Mark
7 2�11
iNSrRUCnorvs: ^
70 6e filed in person or by mail with the CounryAUdito( or Counry Recorder o/ the cbtrFf�'1���mpeAy is located. Fortn Aed w0n:
Fdirg Dates: 7) Real Property: Must file durirg the year /or which fhe deducLOn is sought. ��Cp���y q���p�
2J Mo6de / ManufacNred Fbmes rrot assessed as Real P�g����5�i/g dun g t eNe (72) monfhs
before March 37 o/each year tAe deduction is soughG �'uNTY AUDI70R ❑ �^b Recorder
Sce reverse side tor adtlitional inswcGons and qualifications. .
D' I Key �wm / iegal desaiption (/
�o�'(c` �G-d�..3�-�00-000.8��od�
ed raqe d real PWertY as W Mort�age / Contrad irdebtedn�s unVaid az W Morigage / Cmtra�Y
1. aarenl Ymr March t. artren� Year /1 �-. _' _ tlate of aGP��^
euct
G�r��l
Name of rtnngagee «mntrxi se0er
of aOP�t uMirate bebw:
�
e. ard
Dra���er NO ...................
Card\O . .....................
�� .� HAu KE ��h,
i-IELE� m 1��� - �l J�3(v —
app�wed in ihe amount oE
20
Sig�aMe d . Au�
I / We certify unde
owner / contracl b�
SigraLVe (owneYs IuB r
yWl 'Ce�¢
CJ /U.��
Person au4mmed Gy Ai
20 � 20
Wha� Taring District7
IUNTYAUDROR
2�
Recwd
Is Ihe applicant Ne sde
�gal a eQuiHtle awfrYt
❑ Yes ❑ No
Is iM MoPenY in qurstim: MnueOy AssessM
❑ Rea� Pfoperty ❑ amuanyacse.ssed
Mo6de Fiatie (IC 61.
ihis de0uaion been 2auesred m v��Y
��� �
❑v� ❑�
20 I 20
V , _. ��=a�-�i
ihe penalry of perju that the abov rM foregoing intortnation is true and cortect a�M that the applirant is a resident of IMiana and
yer of the a(wementioned property date application is filed.
„�, �,.. ��/ D. � _ �a ��. aey �a�
/_ _ ��% _ �Jn /�
5tate. eM ZfP
person (numberaMStreetdry.slate.andZlPCatle)
Date (monN. daY. Yea�