HomeMy WebLinkAboutMortgage_Arnett^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n 7 sh Year
• FOR DEDUCTION FROM ASSESSED VALUATION
:, — . .
� Stale Fortn d3709 (R71 / 6-09)
�' ,,,. f Presoibetl q oepertmeM at Laral Gv+emment F�nance f� 11
ti e
INSTRUCTIONS:
To be filed in person w 6y mail with the Co�ntyAudito� or Counry Recorder oJ Ne county where tFie property is located.C' �'
Fding Dates: 7) Real Property: Must file during the year for which the deducUon is sought. nry Audimr
2) Mo6ile /ManuFactured Homes rrot assessed as Real Property: Must file dun�g the hveNe (72) ��SbbN C UN�qIlDLTiQRecorder
6efae March 37 07 each year the deduction is soughi.
See reverse sida 7or additional instmcfions and quali�cations.
Appfxant (owne� or mv2ct bN'�- see resnicnms m mverse e)
(� ., ti �--9-� �� _� �_�T ,
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armay�r
ofinterest?
tt �me on
Address of rtnrtgagee
w oNer awnet w
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ut9eae / Contract'uW�
and streef, cdy, state, aM ZIP cade)
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Does a�N own p(operty in any oNer If yes, whal munty.�
munry m IMiana?
❑ Yes No
ic0on apryweC in Ne amount aF.
20 20 20
1 az af Mongage / Cono-aUU'vMe6tedrress unpaid as of Is tAe eppkanl Me sole
date of apP�� kpal «�puitade owfmYl
�res ❑ No
If wmed wit� somearre dher Ihan spouse, iMicate wqh wfiom
P(oOertY in Questian: Mnually AssesseA
�I P�oPenY ❑ �Y�
—� What Tadng D'stric[? I Fk.
far�
)UNTYAUDROR
20 20 ZO
/
���\~� �� 1�✓ •.
J
C�'�� •S �`�'�,
l,
es ❑ No
Da[e (rtpnfh,
fi�7
I I We certify wder Ne penalry of perjury thai the above arW foregoing intortnation is true and cortect arM that the applipnt is a resident of IrM'gna arM
owner I contract buyer ot Ne afo2merttioned pmpe n date appiication is filed.
�rew e�(�e's hID rem _ Date (nmfi. daY. Yga�
executed Poxer W AttomeY w by IC G7.1-12-0.7
person (number aM stree; crty. state. aM
Oatc (rtmlh. daY• Yea�