HomeMy WebLinkAboutMortgage_Shoultzn STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_, , FOR DEDUCTION FROM ASSESSED VALUATION
Smte Fortn C3709 (R111609)
�,w. Presm2atl CY �M ol Lod Govemmerrt Fi�w�ca .
F rf
wsrRUCnoNS:
To be fifed in person a by mad with !he CountyAUditor w Counry Recorder of the wunry whera Ihe property is located.
Flling Dates: 1) Real Property: Must fila durrng Ne yea� for which Ne deduction is sought
2) Mo6de / Manufectu/ed Homes rat essessed as Real Pruperty Must fiie dunrg Ne tweAre (12J months
6efore March 37 01 each year the deduUion is sanght.
See raverse sida far addifiunal instn�cllons and qualilrcafions.
�������
Mm�h 1. anerG year
I( no. what is his I hu e�l shara of inte�est�
tt fame m rem�d
/legeldesaiption
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u mntrad srLer (mwn0er end stree4 �Y, s�ffi, aM LP code)
Nama of assignea or oNer owner w hdder of morcgage
Adarea of a� (��mber arM stree� �: sWe, anc
Ooes epptitant own 0�7P+�Y in a�ry aher
munry in Ind'ana?
❑ Yes o
Deducaon approveC in tlre amount of.
20 _ 20 _
u,res.,N,a�muncyr _
CAUNI
20 20
IU
Auditor
Recadu
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ite af aPP��^ �gal W�da owtceR
es ❑ No
h wm�ne other than spwse. udimte wtttf Mtrom
�perty in 7uestan: Mm�eDy Assessed
�rtr ❑ a.!?u!aM.a�ssea
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5.i�.(�„30 "oa,
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oa�e (�wler�. dav �ea.�
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D�Y
Q No
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� I I We certify uMes Ne penalry of perjury that the aDOVe and fwegoing in(ortnation is W e and cortect arid Nat Me applinn[ is a resideM of I�iana aM
owner I contraa buyer of Ne aforemer�tioned property nn date applicalion is filed.
( Sia�wre (awne/s futl remel Date (mmtli. daY. Y��
ot appfiont (numbeCdne sLeeL �1: ��.
D�+�
t42-07
streeG �: sfa/e. aM LP mtle)
daY. Ye�)
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