HomeMy WebLinkAboutMortgage_McKannan^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Couni
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� FOR DEDUCTION FROM ASSESSED VALUATION
� Sta[eFortnd3709(R71/6-W)
�• 1 Presaibed by DePan�rrt of Local Govemrtrent Firerce
�JSTRUCT10N5:
To 6e filed in person of by mail with (he CounlyAuditor or Counry Recorder of the aounty where the pmperty is located.
Filirrg Dates: i) Real Property: Must file dunng fhe year for which the deducfion is soughf.
2) Mobde / Manufactured Homes not assessed as Real Property Must file dunng the tweNe (72) monfhs
6efore March 37 0/ each year the deduction is sought. 7
See reverse s�e (or addrfional instrucfnons ar�qualifications. /
MP���( arcoritrdaAuyer-sea onreverseside) _
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M3iCh 1. aa2n[ year
11 no, what fs h's ! M
tl riame an rem`E s�
OL � L
�. / ContraG h
wrrenc year
Nat of appfrant. irMinte beWw
Name ot mort9a9� ar mnttaU se0er
Address of mort9a9ee or oontratl se�
Name W assignee a oMer owner or 1
' U(JV•
s unpaid a af
ctiy, state, eM LP cadej
�iY�nry 64qpr
p.�.��
COUNTY
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mdebtedrms5 �mpaid as W Is Ne
�., n /1 /) C� '�' �
If owned vriN someona oNer Can
Yes LI No
Is tl�e property in Questiwr. MnuaOy AssesseA
i� RP21 PfOPCf�y � �� ASSPSSCd
gnee (number aM slreeC � � I
I ,�, (I[ i1'�G� R��� � . /3 �
ovm property in eny ahu I I\ 1..�� � fw cuirendeduGion Eeen reGUested on praputy
a. � Yes ��I S U m m�:2 �- I�A ��A� � Yeafi ❑ Yes ❑ I
ui Ure amount
zo �
��wre w co�,n a�e��r
I/ We certify under �he penal
owner I mntract buyer of the
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� �w� �evuem � c�a m aYN_"I°' n v...o. o� ��
(�i ���( �PrS�,
Person autlro�aed Dy tluy ezecutetl Power of Attorney or by IC 67.142-0.7
AAtlress of authwrzed person (number eM s�ce4 �'fi'. �te. anC ZIP oodel
� _ , Zo
Nat the applicant is a resident of Indiaria aM
Date (monfi, GaY. l'ea�
Date (rtanN, tlay, yea�