HomeMy WebLinkAboutMortgage_Riley (5)'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
N• FOR DEDUCTION FROM ASSESSED VALUATION
:�—
� State Fortn d3709 (R11 / 6-09)
�' � Presaibed by Department o( Loml Govemment Firence
�VSTRUCTIONS: F
fo 6e filed in FO�I�� �f �1O �
person w by mail with fhe CounryAuditor or Counry Recorder of the counry where the property is located. LJ �i� �� �
Filirg Dates: 7) Real Property: Must !le dunrg the year for which the deducfion is sough(. Y 1 Wun Au i r
2J Mobile / Manufectured Homes rwt assessed as Real Property: Must file during the twelve (72J monfhs ,F�
before March 31 oI each year the deduction is sought `tJ'� be�
See reverse side (or addi[ional instrucGOns and qual�catrons. n __
�
�
pope+ty as o(
ofinterest?
If rwne on
Name of rtrortgagee or mntrarl seller
Mdress of mortgagee or contraa seller
assignee or aher awner or
Dces appikant own property in any oNer
counry in Indiana?
❑ Yes
__..._,,,_ G,._.. _ li0'�/�% Da
^ MoRgaBe I Contraa ifMebtedness unpaitl as af Mwtgage / Canbac[ ind�
Ma�rh 1, artent year date of appliration/ �
if owneE wiN someone other ihan
an4 �dlnte Celrnr.
r f. cRy. state. aM ZIP code)
state,
No
If yns, wfiat munty?
I numbu Pag�e ny br1
G /� 7—"
as ot Is Ne appiont Ne sde
legal w epuitahle oxneY?
� ❑ Yes ❑ No
iMicate wiN whom
Is ihe pmperty in Quer.am: Mnually Assessed
❑ Rea� vrovertr ❑ nmu,a�y n�
o?• �d'% Ac
Has Iha deduction Deen repueste0 m propeny
rw a,�� y�r.
❑ Yes ❑ No
� COUNTYAUDROR
Drdutaw� approved'v� �he amount of.
20 20 20 20 20 20 _ 2(1 _
SignatureNCambAUd¢or Caunry �� �. .____'_'_'___'_
I/ We certify uMer the penalry of perjury that Ne above aM (oregoing infortnation is We an D �-� �}• C I� l�i��o�
v.mer / contracl buyer of ihe aforemerttloned property on date appliqtbn is filed. .............
�
S�
! state, antl
,VtwneY or M �C G,.,-, 2-0.�
P4tlress of auN.wrzea per�..on (num0er antl streeL WY. sfa(e, and LP code)
Card \`O. .......�.
...........
��o &►.,� � i a?, 000. pO