HomeMy WebLinkAboutMortgage_Dike"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,_ _. FOR DEDUCTION FROM ASSESSED VALUATION
. . ' State Fdm C3709 (Rtt / fi09)
S.w. j PrestriRN by DepaM�eM of loml Gwemrtierd Finance
�VSTRUCTIONS: @�
0 6e fiied in person or by mail with the CountyAUditor or Counry Recorder o/ the county wAere [he property is located. ��
Filing Dates: 7) Real Property Must file dunng the year for which tha deduction is soughL D�� Counry Audimr
2) Mo6ile / Manufaclured Hortres rrot assessed as Real Property Must �i e durirg the twelve (72) months
6efore Mamh 31 of each year [he deduclion is soughG C. . (y Recorder
See reverse side lor additional instruclions and qualifications.
App(xant (Qirner or contlact 6uye�- see res4irL'on� rere� side)
Taang Di Key iwmber / kgal desaipUm RemrE rwmber Page numDv
,ts��.c�c/ �6-/9- -�od-000. 6o�-a�6 � i� 53a �'
p� vdue <i mal pop¢rty as W Mmt�age / ContraR iMebtedness unpaid as of Mwtgaye I C,on;raq iMebtedr� unpaitl as d Is Ihe applttsnl the sde
MarM 1. anan year Mar� 7. a�rterrt yeer da[e of ePP��^ legal w equitade mvnM
�O O D ❑ Yes ❑ No
I/ ro. whal is his / Mr e� share of inteiest? ff awned xiM sortware dhu Ihan sPW�. ifdka[e wiN wMm
If rwne m rem�d a 611Ment Ihan Nat of aPP�. mAipte belaw: I5 tM property in VuesUm: Mm+aOY Asussed
[�R�eal PropeAy Q Artnually Assessed
r.�..�.� u.,...e nr <� � _:
or mntract seller
Address o1 mrtga9ce w wntratl se0er (numbar and sLee4 uN, stete. anE
Nama af assignee w other awner or hWder of rtnrtgage
AGCress ot as� (numher a� ;hee4 �Y. s+at?and ZIP� e) '��
� W �
Dces applimnt wm p(operty in anY other If yes, what county.+ W�al
counry in Indvna? � Yes ❑ No
D¢OuCtiOn appfo.�ed m NB amaunl oE
20 I 20 _ I 20 _ I 20
IreNrO W Co�mty MidifOr
�' .-T `�e,..�a ar,�.
I I We certify under the penal of perjury
owner / mntract buyer of Ihe afwe�entic
Di-awer NO...c�C��.�.......
Card 1�'O. .....`�r.�.......
�ori �� O �tJw�c.e
� � .ICb� . QO/ �a� P�y
20 - � 20 � 20
Da1E (rtprM. daY, Y��
above arW foregoing infortnatlon is We and cortece arW Nat Ne applirant is a resident of Indiana aM
�erty on date applicatlon is filed.
Date (rtmm. daY.l�an
state,
Person auNOr¢ed �y Guh/ ezecuteA Power of Attomey m by IC 61.1-12-0.7
Pddress of aWwr'ved person (numberaM saee4 �: slafe. and ZIP mtle)