HomeMy WebLinkAboutMortgage_Conklin�'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun'
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn d3709 (R71/6-09)
�' PrrsmbeE 6y DepMrt�errt of Lo�l Go�emmerrt Firwca-
INSTRUCTIONS:
To be filed in person or by ma� with the County Auditor or Counry Remrtier of the counry whera Ne poperty is bcat�
Filhg Dates: i) Real Pmperty Must file durirg the year for whicA Ne deduction is sought.
2J Mobde / ManufaCUred Homes rrof assessed as Real Prt�perfy Must file dunng Me hveNe (72) rtanMs
before MarcA 31 oleach year the deduction is sought.
See reverse side (or additional insUuctaons end qualificatbns.
�W,Cw�ry (owrieromrmaa buyer- see m re.erse stle) /7 Q /1
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� Tmon�c�pp Key rniim0et / kgal desv�tion
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no. what ls h"a / tcr evG
narna m recatl b CHfua
Name m rtnr�ee ar mnexc seeer
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Addresv of mortgag� «mntrect se�er
Name af assignee w dhrl owner or twl
AEEress of asagnm (numDar entl srtre
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Cou itnr
NO 5�,����
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Y� u No
IH wmeC wkh somew�e atlmr tlan spouse. udirate with whom
uMksm 6etrx. Is Me P�PenY in questm: M�uaM Assessed
[� Real PmpertY ❑ M^ually Asessed
7- Madle Fiatie (IC 6
nar4jaga
timrrt wm C�PenY in anY oNer
InEara?
❑ Yes ❑ No
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antl LP caCa)
If yes. wh[
llrawer NO...a� � �.......
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p_ 20 20_ 2�_ 20_ 20_ �_
Signance U Cow+N Autlitw Counry Oata (rtnntlr. OaY. Y��
I I We certify under Ue penalry M pe�ury ihat the above arM foregoing infwmatim is We and cortect arM t�at Me applicant is a resident of Indiana aM
owner / contraG DuYe� M Ne aforemeMbned P�rtY on date aCPlication is filed.
Siarewre (owneh hN name) !� A 11 Date (+m'rth, daY. Y��
rrsident adOress d appfxant
i�ly esecu:etl Pwrl ofAtpmeY w Cy IC 61.1-12-0.7
G� (numberaM SneeG �: s�te. an0 LP mtle)
Date i�h. �Y. Y��)
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