HomeMy WebLinkAboutMortgage_Rembe^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS r s p Year
_. FOR DEDUCTION FROM ASSESSED VALUATION
. State Fofm 03709 (R71 /fr09)
,' rw PRSfribeC �y �epartrtieM of LOCaI Ccvemment Flw�ce �y
INSTRUCT70NS: O�� Ie�,o
To be filed in person w by mail with the County Audrtw or Counry Recorder of fhe county where the property is bcated. F� ��
Fi1'mg Dates: 1 J Real Property: M�st file dunrg Ne year for which Ne detluclion is sought. ty Auditor
2) Mobde / Manufactured Homes not assessed as Real Proper(y Must fi7e dunng the tweNe (72J monMs o' �
befwe MarCh 37 of each year the deduUion is souqht.
G�950N 0 Y A �ef
See reverse side lor additional insVUCGons end qualifications.
nvWmQt(pwnerormrmraa�r-seerem"rson�nmrersesi7e) � / � _
PsusseC raNe U real pfoper;y as d
MMh 1. a+�art year
v���,�.— c
ii a�
II n0, whal'6 his / hef eraQ Shara Of intaresi?
tt iwrn m feodd "s 6ftemnt than Nat of aPP��t InOicam Delo�wc
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Address of rtnrtgagee ar mntrad seDer (nu and sIIeel, ', slate.
Nartre m avsignee w atl� awner w ndeer of monpage
MOrass of avtignce (nwMer eM sbcet �: s�te, and LP cak)
Dces ePpfi�r�t ovm property in any other If yes, what m
muNy �n InOFana?
❑ Yes ❑ No
Deduction mwoved Cie amount of:
as d I Is ihe eCP�+� iha mle
legal a epuitable wmM
❑ Yes ❑ No
rc�,aa �m � m,� m�, s�. meKSU �.ms, �w,�„
COUNTYAUDROR
20 � 20 � 20 � 20 —
Counry
M�weOy AssesseE
u
i
�O�D ...... —
Dra��er \ .............
Card \O. .... �iO ,r�,�.......
� i ia,a i4 `� ',"�'� '
� ..... �. • I
2p — � 20 — � 20
I I We certify under Ne penalry of perjury that Ne above arW foregoing infomiation is true and cortect arW Nat Ne appfipnt is a resident of IMiana aM
owner / mntrac[ buyer of Ne aforementioned property on date aPd��n is filed.
3�W2 (N�h hd� /l�) A8 . �/� : p Date (nbRh. dal: Y��
�
Pvsan autMrsed Cy C�lY ezewced
D�
sLeeG aN. �. antl LP cade)
cdy, staR, entl LP mde)
Date (manN. OaY. Y��)
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