HomeMy WebLinkAboutMortgage_Dearing"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Fortn G3709 (R11 / 6�09)
, f P�esrtibed by DepartmeM o( LOCaI Govemment Fu�ance
File Mark
INS7RUCT70NS:
To be filed in person w by maii wifh the CountyAUditw or Counry Recorder o( the county where the property is locafed. F� �� ��
Filing Dates: 7) Real Property Must �le dunng the year /or which Na deduction is sought. Cou d r
2) Mo6�7e /Manufadumd Homes not assessed as Real Pioperty Must hle dunrg the fweNe (12) monfhs
6efore Ma�ch 31 of each year the ded�ation is saight.
See reversa side for additronal instrucGons and qualifications.
I AppGwnt (o r oraontracl buyef'see m�UOns on ve sidej '
� - _ _ -_
Aa�sed vdAie af real prapel,y as MoRgage / ConvaG'v
i t. a�retl year Mafd� 1. wrtenlye�
, �Q
rc �a, wt�at ts nis � r�er ema stwe or inrr�t?
If riartre m 2ard is Qd}erem Nan Nat ol apPlkan4 mdinfe b a
�
Ndti12 01 fIpR039C8 Of (bfIV2f15¢DEf
unpaid as of
Addres d rtrr��age� or mntraa sr�u (mmbri erd sveeL �l: sta�. eM LP cade)
assignee w oUrer owner w talder o( mortga9e. _
Dces applicant wm poperty in any oNu
muNy in InOiana? ❑ Yes
D¢tluGtlon appro�ed in �he amounl of:
20 _
Sig�me d Camry nuertw
s�ate,
No
� i I `�°�`iQa
tlata
If owneC with someone other than spouse. indirate wtth whom
_ �O � �.........
j�1'A�YCI' \�.........
� - 19� � ......
- s��� . . • • � �?,i��`��
20 _ � 20 _ � 20 _
Caunry
Yes L� No
is me WoPertY in 4ues6on: nnnueM Assessed
❑ Real Property � Armualy A5ses5ed
20 � 20
D2�e (monN. daY l��
� P�Y
20 _
I/ We ceriify under Ne penalry W perjury Mat Ihe above arW (oregoing intortnaiion is We end cortec[ and Nat the applinnt is a resident of Irdiar�a and
owner / contract b�yer of the aforemen[ioned property on date application is filed.
I^a�re (owner3 hN rertre) Date (morrtli, daY. YBe/)
sfate, eM ZIP oode)
AEAress of auiha'¢cd person (numDer arM street, dry; sfate, an0 LP ootle)
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