HomeMy WebLinkAboutMortgage_Hellums'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 03709 (R11 / 609)
�,,,, � PreSaiDetl Oy DeV��rtl of Laai Go�mmment Finerce �
INSTRUCTIONS:
To be fded in person w by mail wiN the CounryAuditor or Counry Recader o/ the counry where Ne pioperty is focated.
Frling Dates: 7) Real PropeRy: M�st file during Ne }rear for whicA Ne deduclion is sought.
2) Mobde / ManufaUUred Homes rrot assessed as Real Propelly Must file dunrg fhe fwelve (12J rtanths
betore March 31 0! each year the deduUion rs sought.
See �verse side (oi addiWnal instrucUons eM p.�lfications. I
KeY nm6er
�,��d�,�.ffi�
n/aU t. ai�eru year
n m. wnai �s ms i n« e� � or H�areua
ial-C�o. a�� -�7 I aG�
ss unpaid as o( Moriga9e / Corttracl mEe6tedne55 unpaid as of
�� a� m avvr�no�
tl rurtre m remA is Eilfe2nt Wn tnat W apP�t Inakate Debw:
Name of rriortgagee m m�vaU se4c ��
Address of mart9a9ee ar mntrad se�er (rumDer end shaeG laY. sfete ard LP cade)
Name ol assignee m oNer ownc or MolOm d mart9x9e
AdErms M assignee (num0eren0 atreel �: �. eM LP co0e1.. -
oc« epa�mm wm wocem.�n �"' _ -
munry in IndanaJ �O, �. . . . • • • •
— �1�"C� ��..
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Cal � ��, .. �
�_ � 9�,�.
Signad�re d �
If ovmaC wtth someone otM1 fhan spouse.
,� 'u�n7ty Aud'ROr
�C�lA�ervrder
ritaHe owne(/
Yes ❑ No
is Ihe property in Questian: Mnually Assessetl
� Real PmPertY ❑ %��!!a�1! �
Has Ns detlumm Eeen requested m pmpuly
for artrent Y�R ^ _ _ �--�
COUNTYAUDROR
20 _ 20 _ 20
Caunry D
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I I We certi(y under Ihe penalty of perjury that the a6ove and foregoing infortnalion is We and mrrect and that the applicant is a resident of IrMiana arc1
owner I oontrad buyer o( Ne aforeme�oned D�Perty on date application is fileG.
maWre lox+�ers fiAI �me) , n n Date (rtwu�th, daY. Y��
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r
person (num0er aiM street pN, s+a�.
and
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