HomeMy WebLinkAboutMortgage_OConnor^�+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
::_— �
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn d3709 (R71 / 609)
� B P�p� py pepy�¢nt ol Lad Govemment Finance
File Mark
1STRUCT10N5: F� �� ��.
To be filed in person a by mati with fhe CountyAuditw or Counry Recorder ot the county where the pmperty is located.
F7'mg Dates: 1) Real Propelry: Must file dunng fhe year for which the deduction is souqhf.
2) Mo6i/e / Manulactured Homes lrot assessed as Real Property: Must file during the fwelve (12J months
before March 37 of each year the deduclion is swght. ^ �
See reverse side.Iq�Nddifional instructbns and qvalifirations.
0 rdue d mal PnD�Y a d
�t yrar
at is ha ! her e�ct share of inferesi?
m remfd is EHFe�ent tlwn Nat o( appl
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Mor�page/COntran
Mart3i 1, curten[ ye[
belo�r
t+ameo�mon�azjee«cmvarlseuer � /y_�
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Address of mort9agce w contrad srder (nwribei end sbeeC�� sbL.e, aM �
Name o( assig�ea v othel owner or holdu N mort9age
AdCress o( a nce (number aM stree4 �Y. s�te. and Z�P wAe)�
�r SE 3 ��
Ooes applipnt ovm property in any oNer If yes. what munty.�
counry in IMiana? n Yes ❑ No
tluction app�oved tri ihe amount oE
zo _ zo _ zo
;rew2or ryAUeimr
�T. �u-�'�`-,
I I We certify under the penalry of pe ry that Ihe
ovmei I contracl buyer oi the afwementioned pro
00/. `���-U.17
paid az of Mongage / ConbaG intle6tetlnes
� Oate of BppGCatian
If wmed vriN someone oNer than spouse,
a
COUNTY
_ 20—
Counry
e and foreguing infortna�on is
on date appiication is filed.
Yes LI No
perty in Quwtim: PnnuaDy Assessetl
Propenv � A^^ua�Nnssessee
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�ver NO:..°�.Q�.a.......
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�rW. daY. Y��)
is a resident of Indiana aM
FWI resi— �Eeni ab��ress of a rant �umDer antl street, ril}; state, aM ZIP cotla) J,
� Y 1 7 �9 �7
Pe1mn autlro' bY tluty �ewted Power of Attm�eY a M IC G7.7-12-0.7 �(�h. �Y•
Addr�s ot a�rthortred persrn (number arM shee4 �Y. stafe, arM Z!P cade) .