HomeMy WebLinkAboutMortgage_Brown (6)_"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun�
_ FOR DEDUCTION FROM ASSESSED VALUATION
• Slate Fortn A3709 (R71 / G-09)
�' � Presaibetl by OeparbrreM of Lod Goremment Frence
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INSTRUCTIONS:
To be filed in person w by mail with the Co�nryAuditor or Counry Recorder o/ fhe county where the property is lacated.
Ftiirg Dates: 1) Real Properry: Must file durirg tha yearfor which fhe deduction is sought.
2J Mobde / Manufauured Homes rrot assessed as Real Properly Must file dunng tAe hvelve (72) months
6etore March 37 0/ each year the deduction is sought.
See reverse side /or additional insfructiau and qualificafions.
npp6ram � oroon+raa b see res7ictans m re sife)
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7ari� j� , KeYnumber/Iegaj,QesmVt�g4 .. .. . _ .
7. arm�V year
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% 7 / 7-f/!V• �. - �LtF-J/
MoRgage / Conlrea 4debteEncs unpaid as of
MarU 1, arrerrt ynlu
It rNme on RmN's 6Refntt N3n Mat of appOCan4 c�tliCate belwr.
Name of rtartgagea «mntraG seller
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Pddress of mo�gagce or mntrad se�u (n�mibe� end '. s7atB.
Name ot assignee w other wmer or halder M rtqrtgage
[yiee (numbe� and stree; tlty. sfete. antl ZIP code)
wm poperty in any dha If yes. whal munp?
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�f� ❑ Yes
Deducfion approved In tlre amount
number
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azd
Cou Auditor
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Yes LI No
Is tice 7�P�Y in Vuestion: MnuaDy Assessed
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Modle Home OC 6
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4UDROR
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20 _ 20 _ 20 _ 20 _ 2O _ _ �u _
Sig�wre W CamNnWitor Counry Date (nmfi. daY•Y�d
1/ We certi(y under ihe penalry of perjury that the above and toregoing informatlon is W e and corretl arW Nat the apD���nt is a resident of Indiana aM
owner % contract buyer of the afinemerrtioned property on date apPlication is filed.
of appGrant (numDer ana sbee4
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Pnson authar¢ed �y duly ezecutetl Powcr dAttorney w by IC G7.1-12-0.7 I DatE (monN, day, yean
Address of aWmr'ved pe�sm (numbe�an0 stree; ciry, state. an0 LP code) . .
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