HomeMy WebLinkAboutMortgage_Rahman (2)'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T sni vear
__,. FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 03709 (R71 / G09)
, w. Prewibed tY ��rd al Luml GovemrtroM Ftwrx
File Mark
INSTRUCTIONS: Q
To be filed in person or by mail with the County Auditof or Counry Recorrle� of Ne counry whe�e the property is !ocated. �
Fding Dates: 7) Real Property Must file durirg the year for which fhe deduction is soughL � Counry Auditnr
2) Mob�7e / Manufactured Homes rrot assessed as Real Property: Musf fiie dunng the tweNe (72) months ` iM �c-�,(�,(:_.. Reco�du
6efore March 31 ot each year the deduclion is sought. �T �r�
See reverse side (oraddifional insVUCGons and qualficafions. GIBSON
Aoo&an� (o�mer � mpUaC buYEr- see resnictions m reverse sidel .__ .
1 vWUe d real pmpercy
amnt yrar
descnDtirn
+eur1 snare oi intemsY!
d'RFe2nt Nan ihat a/ appOmnt,'uNira� bebw.
rnortgagea «�o-aa se��¢
��I
d rtiortgagee ar contracc se
assignee w oNa wmer or
mortgage
1�
sbte, ard LP code)
Pddrrss of assignee (numbei and stree4 my: sb1e, and LP ootle)
Does aPpli�aM wm property in any oNer If yes, whx
munry m Ind'ana?
❑ Yes o
De�uctian aPWO`� In ihe
RecorE numhar P e number
- OO o 1 g`i - d lp �.��1 �
npaid as of Mortgage / ConiraG uMebtedness unpaid as d �s t�e ePpikant the sde
Cate W appGcation �egal ' de ox+relt
es ❑ No
tt o�vned vriM saneone other tl�an spouse. uidimte wiN whom
��s{y.,�1 property in questim: MnieBy AsGised
I7�teal ProPeAY ❑'MwiaDY `0.sessed
1' MobOe Fbme OC 61.7-:
COUNTYAUDROR
H
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FF�iD cJ
I�� i�- ma�, C�
p�plo -'���v
p_ 20 _ 20 _ 20 20 20 _ �_
Sig�anne d Camb Aueitor Counry Date (rtmN, daY• Y��)
I I We certify under Ne penatty of perjury that the above aM (oregoing infortnation is true and mrrec[ arW ihat Me applirant is a resideM of IrWiana aM
owner I mntraci buyer of Ne aforemenfioned property on date appiiqlion is filed. _
Pddress W auCmr'¢ed pe�son
rmDer anE sbeet, dry, sfate, and ZIP mEe)
S�mmo-n 1�.,o D,
ao�re. orav�r or br �c s,.,-,z-0.�
Seraid sfreet, rily, sfate, aM LP mde)
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