HomeMy WebLinkAboutMortgage_Yeryar"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ : FOR DEDUCTION FROM ASSESSED VALUATION
• Sta[e Fortn d3709 (R71 / 6-09)
�' � PresmLed Dy DePa�nl of Lod Gwemrtrent F�nce �
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INSTRUCTIONS:
Fortn Red wflh:
To be fiied in person or 6y mail with the CountyAuditor or Counry Rernrder of the counry where fhe property is located. C T� O��
Frling Dates: 7) Real Pmperty: Musf fi/e dunrg Ne year lor which the deduction is soughG d���
2f Mobde / Manulactured Homes rrof assessed as Real Property Must file dunng Ihe IweNe (12J monNs
6efore Malch 31 of each year the deduction is sought ❑ Counry Recorder
See reverse side for additiunal inshuctions and qualifications. � // � //'
Tatieg OisUicY // numEer / legal deuri '- �/ // Retortl numbes Page numbqrl�
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Assessed vahm d rcal property as of Mortp age / Contract intle6tetlnrss unpaid as of Mortgage I ContrarY indehtedness unpaif as o( Is Ne appl [ the sole
Mamh 1, Wnent year MeRh 1, artent ynar da ¢o( ap kgxl or de qme(.+
I o� d� Yes ❑ No
If ro, what ¢ h'a / her e�atl share of internst? tt owned with someone dhrJ ihan spouse. uMipte Mith whorn
If name m tecmd is diRUent tAan that W aDP��t mdicate Gelrnr. Is property in puesDOn: MnuaDy Assesse0
� Real Pmperty ❑ Armualy AssesSed
Modle Haiie fIC 61.1-i
Name ot mort9agee or conVau seller �/ /
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Atldress ot rtnrtgag� or mntrad se0er (number and sneeG cRy, sfa�,
Name N assignee w oihrr owner or halder af mortgage
AddresS Of azsignce (numOer aM stree; tlry, s!ale, and Z/P tode)
Does e�irant wm pmperty in any oUer If yes, what m
cwMy m InC'ana?
❑ Yes ❑ No
COUN7YAUDROR
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Sig(utum of Counry Auditor Caunry Date (monM. day, yea�
I/ We certify urWer the penalry of perjury thai the above arW foregoing intortnalion is We and correcl and that ihe applicant is a resident of Indiaru aM
owner I mntract 6uyer of the aforementioned property o� date applicatlon is filed.
Sian3IDRiowners fifi name) � Date (rtmfh, daY. Yaar)
'�eM �dof apacarit (number antl 4 tity�tate, and ZIP code)
2( ' � sT i � 6�{
utMmeE Dy dWy e�ecuteC Power o! AtlneneY ��' IC Gt.t-t 2-0.7
of autlror'ned person (number aM sbeef, ury, stale. an0 LP code)
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