HomeMy WebLinkAboutMortgage_Hyneman (6)^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
__ = FOR DEDUCTION FROM ASSESSED VALUATION
� • S1ate Fortn d3709 (R71 / 6pJ)
` t Pr¢soibed by Departmeril of Local GovemrtreM Fuanca �
"� File Mark
�VSTRUCTIONS:
F
To be filed in person w by mail with the CouniyAuditor or Counry Remrder ot the oounry where the property is located.
Fiting Dates: 1J Real Properry: Must file dunrg the year fir which the deducliun is sought � ditnr
2) Mobde / Manufactuied Homes rrot assessed as Real PropeRy: Must hie dunng the twelve (12) months � �u R er
before March 37 0l each year the deduclion is sought.
See reverse side for additional instrucGOns end qualifiu
Ap�wnt (owneror - s resl+fctions m rere
., T' � Key rvun er / legal dw
_ f
ve4iec(real d MoK9a9e/
Maich 1. aarem 1mr Mamh 1 a�
If no, whal is his / her exact share of interest?
11 name m�em�d'a diRemrt ttun ihat of appGCani, irMi�ate d
rya� o{ �gag¢¢ or mntraU utler
Adtlress of nwrtgagee w mntracl seAer (number and slraeL c
Name W assignee or ather owner w hdEer W mortgage
AddRSS of assgnee (numOeraM streeL �: state. and ZIP t
Does eQplvant o.vn p(oputy in any oNer If yes
counry m Ind'eru? � YES ❑ No
/
roniv�irn aoemve� m the amount of.
20 _
sy�awre a co�mrya,aitw
slafe. aM
what munp?
2°- � 2°-
DU
•� •�� •1� •-
a5 of I Is V�e epp6�nl U�e sde
legal a equitaNe oxne/?
n Yes ❑ No
someorie other ihan spouse, iMkate with whom
v�vem �n o�esriw,: nnrwaM �sea
�I Ptoperty ❑ Mnua��y Pssessed
Dra���er \To..a. a�a........
f�q5 "�'
� Card NO. ..'.. ` ............
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m property
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I I We certify under the penalry of peryury Nat the above arW foregoing infortnaGon is W e and mrtec[ and that (he applirant is a resident of Indana and
owner I contraa buyer ot the atorementioned property on date appliration is filed. �
3faLUe (ovmers hN rume) Date (month, day, yee�
lent a0dress oi appfxant (ni
�s,z ,� z o a .
iu�d by d�Y exe�ted
of authoraed perso� (num
tity, stata.
��Yaq
Sble, and ZIP cotle)
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