HomeMy WebLinkAboutMortgage_McEllhiney (4)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS r i vear
�. _-_
; FOR DEDUCTION FROM ASSESSED VALUATION
. Sfate Fortn 03709 (R71 / 6-09)
,' ,«. Presoibed EY Departrtrent o( Lacal Govemrtrent Fuamc
INSTRUCTIONS: AUG �'I���
To be fiied in rson or b mail with the Coun AWitor or Coun Recorder o/Ihe coun where tAe ro F� �� ��
Pe Y b N N P aenY is rocated. C. .
Fding Dates: 7) Real Property Must file during the year Por which the deducfion is wughL ty AuCitnr
2J Mo6Re /Manufactured Homes rrot assessed as Real Property Must file dunng fhe tweNe (12) months
befwe March 37 of each year the dedutlion is saghG Co Retorder
See reverse side toraddd'mnal instruclions arM qualificatbns. GIBSON OU Y AUDI OR
� AF M(oxner or contrarl buyer-s�/ ���e.stricbons m reverse sde) �y/� � /J
'��, � S[�il A// �� �.C�� (X-e.hT�ln'l�iA
umber / legal dewipcion
�o-ta- o �
�i M. W�Id� 6 h6 i h2( C%d(Y
If name on remd is difierent Nan Nat o( appGrant, uMUate belmr.
Nameo(rtnrtgagee
i.300- ooi. GG4� -� a7 / l �.3
intlebtedness unpaid az o( Mortgage / Convact'uNe6ted�ss unpaid as d Is Ihe app8ont Na sok
U l aace oi aOP��� legal n equitaNe aMne(t
� �/ ❑ Yes ❑ No
If wmed with somearie aher ihan spouse. iMicate wiN whom
streef, cdy, slare. aM ZIP cade)
.�c.•� 7 � d —
Adtlress ot assignee (n�mber and street a�: s+afe, and IP code)
Does applinnt rnm ynperty in anY oUer If yes. what couny7
counryinlMiana? ❑ Yes ❑ No
2� � 2(1 � 20
I I We certify under Ne penalry of peryury Ma(�j1Se above and
owner I mntract buyer ot the af«eme�onedproperty on da
' naL�re(owQe/slutlnama) '
R. Mc.�—
u1�2sident address of appficanl (numDer antl snee4 �'nl: ��e, aM L�
I S'�O �as-� S tal2 2�1 6�
P4dress of auNnaed person (number aiM streef, dry, sfate, and LP code)
iZ�7
I5 Ne property in Question: Mmiaoy 0.sseS5ed
� Real PrOPeKY ❑ M^uall�' A55es5ed
,�, m���,-�N�y 3ESSS� � -
_ T��c o No
,�o� / l-.3 U53
— — i —
Date (rtronfi, day, yae�
informalion is We and mrtect and fhat ihe appiicant is a resident o( Indiana arM
ion is filed.
e�1�cN., Z1..1 4-Ib�lO
Date (rtianth, day, yee�