HomeMy WebLinkAboutMortgage_Catt"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
• Sta[a Fortn d3709 (R77 / 6-09)
�' � Pr�rnbed by DeG��rtl of Lad GovemmeM Finance ' �.
File Mark
wsraucnoNS: p
To 6e (led in person of by mail witA the CounlyAUditor or Counry Rewrder o/ the county where the property is located. �
Filirg Dates: i) Real Pmperty: Musf fife dunrg fhe yrear /or which the deduction is soughf. � County Auditnr
2) Mobde /Manufectured Homes not assessed as Real Property: Mus[ fife dunng the hvelve (12J months n �✓�
before March 37 o/each year the deduction is sought. G�C..1'a�NY Recorder
// V
See reverse side for additronel instrtictions aM qualfications. IBSON COUN
MP�dN (oll�� wcon7raC 6uye�'iee ra3blylo')s w iP�erse sid9L7 . i
- - oa-a� �s- aa
Atisrssed vaqc d 2a1 pcperty as of Mortgage/ ContraG intlebiedncs unpaid as of Mwcgege I Con
MarM i. amnt Year March 1, artem yrar tlate of aOP��
tt ro. what �S his J trer euct share N intrJest?
11 name m�e�rorE e WRuent Nan ihat ol app6rant, uidin[e below.
sNlu
contraU snder (nurr�bei end sbeeL u�t sbm.
Name of assignee w othr! ovmer or MIOer of morigage
MEress ol assignce (number antl strec; ray, slafe, antl ZIP co0e)
Dces ePdi`ant am p(operty in any aher If yes. whal counry/7
munry in InEana? r-� .. r� ..
rc wmea wim someme oth� ma� spa,se.
Wlat Ta�dlg Datricl?
� �ww��ev��,..��-
❑ Yes ❑ No
pertyinquesCOn:Anm�e�yASSessed
Pmperty ❑ ArmuallyASSessed
Madle Fbrt�e OC 6
Mas Nis tletlumon been requesteE m propefty
rmcurren+r��' r-i .. r�
COUNTYAUDROR
Deauchon approved'o� tl�e amount at
20 _ 20 _ 20 _ 20 _ 29 _ 20 20
Sigreture d Camb nwimr Counry Date (rnw7h, daY. YeaA
I/ We certfy under the penaly of perjury that the above and foregoing infortnalion is We and cortect and that Ne appluant is a resident of UWWiana aM
owner I mntracl buyer of the aforemerhioned property on date applinlion is filed.
� (oxnefs fu0 ) Date (nwvh. daY. Y�A
� Full revtle appfrcant `number 4� �e. mtle)
'10 ��,e.\� 2 Fo ►.� �. '-i'1��i�
Pe�son auNw'¢e0 bY duty esecuted Power of eY � M IC &1.1-12�.7 Datc (rtronfh, day, yea�
Mdr�s o( aWra'ved person (numberard sbee( dly, sfate, antl Z!P ootle) , .