HomeMy WebLinkAboutMortgage_Burger (4)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
,___ _: FOR DEDUCTION FROM ASSESSED VALUATION
:• State Fortn C3709 (R71 / 6-09) � 4�
�' ,,,� t Presaibetl by Department o( Laal Govemmenl Finance B
i File Mark
INSTRUCTiONS:
To 6e filed in y b N N P Fortn Aed wim:
person w 6 mail witfi the Coun AWitor or Coun RecoNer of the coun whele Ihe Ipp� sk�7 i
Filiig Dates: 1) Real PropeRy: Musf file during fhe year Por which fhe deducfion is soughG J U L� L�I [�ppnLy quditor
2J Mo6de / Manulactuied Homes not assessed as Real Property: Must file dunng the twelve (12J monfhs
befo/e March 37 ot each year the deduclion is sought. C � m�-�--- ❑ Cwinty Recorder
See reverse side !or adUitional instructions antl quali�cations. �.� \
���
eC rahc d reaI WoPenY � of
i.cwentyear
II no, what is ha I her e�d share ot interest7
It name on remfd "s 6rtemnt Ihan
diption /� ' RecorE numhc Page rwmbrl
'/9-/°.-`�ioa -(�bo �8so-oa� f � �i
Contrau intlebted�ress unpaid as of Mortgage / Cmtraa udeMedness un7aid as d Is Ne aDD�� 1he sc
��R�AY9K _ �-.� tlateofaPP�� �egalweWitadeown
Name oi mortgagee w mntraci sWer �.�/
� �
nddress or mortqaqee «mnaaa smer (nurnm• �
/
Name of assignee or oW� � n��/
/ /^ �/
� 3u��-, � �r
� ��
��, � � ��
Detlucfirn �
20
$igria[ure of Counb AuAitor
E'i�]
sarnearie
'M ZIP code)
What Tab�g Disvia7
COUNTYAUDROR
20 20
Yes LJ No
sPW58.
15 rt�e ProPertY in QueStion: Mtwa�y AssesseE
�] Real Pmperty ❑ MnuallyAssessed
Has Ih's detluflion
ror current yeaR
20
Date (rtqrrth� daY. Y��
«� v�cem
❑ No
20
I 1 We certiy uMer ihe penalry of perjury Nat the above arW (oregoing infortnatiai is We antl mrtect and that the applit�nt is a resident of Indiana aM
owner l�ontrari buyer of the �forementioned properry on date ap0���� � filed.
inaW�rc dvne/ 1�llnmiel / _ Dare (rtmth. daY.Year)
�, Z� �76 �t �
ezeCUtetl Power of AObneY a �Y IC G7.1-12-0.7
AGCress d autharze� persm (number and sbeet. tlry, state,