HomeMy WebLinkAboutMortgage_Vaught"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yeat
_. FOR DEDUCTION FROM ASSESSED VALUATION
$bte Fortn d3709 (R17 / fi09)
�' ,.,� PresoiDed C/ �epaRrnerd of LoW Govemmerrt Firetr<
F8e Mark
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b be fiied in person a by mail wrth Ure CountyAUdifor or Counry Retordei of the county where Me poperty is located.
FiPog Dates: 7J Real Property: Must file durirg fhe yaar for which Ne deduction is wughG � Counry Audhw
2) MobAe / Manufactured Homes not assessed as Real Property Must file dunng the fwelve (12) rtiti�yK� �nry Recorder
be(ae March 31 of each year the deduclion is saght �'r
Seereversesideforadditionalinstnx8onsandquel�fications. BIBS6N COUN T H
I Aoofimnt lo�nier mmritraC 6uver- see resbicb'ons m rewrse sidel. i
Assessetl vahie drea
A1a'U 1, am1Y yW
If no. what la his l lcer e�mr�
ren,e m recwtl
«mnttact se8er
Key rwmber I 12ga1 desvipom
d�-ia-�33-zoocr�o $O-7
IMortpage / Contraa irdehtedr� unP� as
Mart3�1 yurtentyear
oew.
d rtnrtgagex ar mntraG sWer (nuMer and street �Y• stata.
Ivame m aswyiee or omu owner w mvar rn rtvr�aga
AdOreu of assi,y�ee (numberantl street �Y. s�.
Dors eppti�ant wm D�P�Y in eny ahc
munry in Ind�na? ❑ Y25
❑ No
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oaa� �cw�a m ure am�,�u or
20 _ 20 _
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number � Page wmba
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Yes LJ No
1( awie0 wiN someone other Ihan spouse. Wicate
ur moe�
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�s me v�a�r � a�sm: n��:
�Real PropeRy Q Prmual
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I I We certify ulWer Ne penalty of perjury Nal the above antl foregoing mfortnatlon is We and correct arW that iha ap�rant is a resideM of IMiara antl
owner I mntrad buyer of Ne afaementionfld Property on date applicatlon is filed.
(ownrfs tw rmrte) oam (morm,. mr, r'�)
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o r�;aem adaress or aca�❑t (numeu ene street cry sra�. ana La mee) .
2ba5 � 3.�dS }�r/nCttOy l'/L 47670
��nn�a ey awr �ea,�a ewor ornu�,ay or M ic s,.,-,za.� o�e (mmm. a�: ree�
Verson (numbermiE sbee4 �Y. smte.