HomeMy WebLinkAboutMortgage_Luke"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
:r"_..
; FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fam d3709 (R11 / 6-09)
�' a� � Presaibetl by �eP���nt of Laral Govemmenl Firence
File Mark
�STRUCTIONS: u E C
6e filed in erson w b mail wiN the Coun Auditw or Coun Recorder of the coun where the ro N'
P Y b h h P PertY is locatea
Fdirg Dates: 1 J Real Pmperty: Must fik durnmg the year (or whiU !he deduclion is sough(. un Auditw
2) Mo6�7e / Manufactured Homes not assessed as Real Praperly Must h7e dunng the lweHe (72) rtanths ��' � ry
before March 37 of each yea� the deduction is sought. � unry Remrder
See reverse side !or additional instrucfions arM qualifications. G I BSON C
Ap�wnt wnerorcontradbuyer-
Tab strct
-�c/% . J
[Y`-...�.ry�
AssesedvaWedmalproperty o(
Mairh 1. aarent ypar
It ro, what is ha / her exad share oi
vde)
�ll— 09—.�DO-D
/ Contratt "udebtedness unpaid as ot
wrtent yrar
If name on remN is dHerent Nan Nat of appfinnt, md'rate bebw.
Name of mortgagee or�6ontraG seller
mntract seller (nursiber end sbeet c4y. state. and
v owner or hdder of rtqrtgage
Oces eppli�nt awn property in any aher
munry in InEena?
❑ Yes
ciry, sla(e, anC
No
wiN samearre other
� � l � �n �f
s unpaid as of Is Me a00�t tlx sole
legal w eQUitade ame/�
❑ Yes ❑ No
iMirate wrth whom
Is Ihe property in puesGOn: MnuaDyl�sessed
❑Rea�ROaertv ❑lw+ualh0.ssessed
C/U �`��S/� '—
Dra���er \O.r�.o%�.-......
ZlPcotle) Call�� /��i�. . �.��.Y...........
If yes, whal m�nry7 Nrtut Tadng D'afnfY? /� '�+`�9^ �1'
�._......._..�-�- r� .. � � ..
COUNTYAUDROR
Deductlon approveC in Ne amount of:
20 20 20 20 20 20 20
signadrte N CamtY Auditor Caunry Oate (month. tlaY. YEar)
I/ We certify uMer the penalty of �ury that the a e and foregoing infom�ation is We and corteU aM Nat the applit�nt is a resident of IMiana antl
owner / contracl buyer of the atwementioned pro on date appiication is filed.
re(ownels fW reme) Date (monN, day, yea�
. � • /
FWl resident ress W appli (ny�nDer dry. t and ZIP e) ,
a.�2� . �+�� 6�I1 y 7 (P �i�
Perwn autM'aeE Ey EWy es ted Power of Attomey rn y I G1.1-12-0.7 Date (rtpnN, Eay, yea�
AGtlress of auNOmsd person (number arM ureet, trry, sfafe, and LPfnLe)