HomeMy WebLinkAboutMortgage_Dixon (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
s FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm C3709 (R77 / 6-09)
� f Presaibetl by DepartmeM af Lnral Gwemment Fuance
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INSTRUCTIONS: �pdu�h
To 6e ned in person a by mail with the CountyAuditor or Counry Recortler of the county where the property is located. F U C l, G�9 � � � �
Fitirg Dates: 1) Real P�perty.' Must file dunrn� fhe }rear Por which the deduction is soughL � �unty Auditor
2J Mobr7e / ManufaUUred Hanes rat assessed as Real Property: Must fi7e durirg the hveHe (72) months
be(ore March 37 of each year the tleduclion is srought � Couyy,j7ecordu
G'� r6� /JK+
See reversa side 7or addiG'unal inshuctbns end qualfications. V V
Mo���MAneroroontraa4VYer-see mraverse ' . '�
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anent yPar .
�t Is his / twi eratl shara oi intr�est?
If name on iecad "n dtlferen� Nan Ihat o/ aPpOfanf, uMip[e below.
Nartre af rtnnga9ee or contract
mortgagee w contrad
' o- Gb/ 3/7- d�?G o�aio "� �s�
aa indebteenPSS unpaitl as W Mortgage / Cmrad'mde6tedn�s impaif as of Is the applkant Me sole
year eate or ava�m�+ /� iegal a ewdada ovme!!
/�D �O� ❑ Yes ❑ No
tt ametl with mmeone Wim tl�an spoise. udirate with xMrn
stata, eM
Name of azsynee w ovirr owner or nmer m rmtgage
��
AACress ol am9nee (num0erentl sneeL m}: slafe, antl LP oode)
Ooes applicant own poperty in any other If yes. what munty�
munry in Ind'ena?
❑ Yes ❑ No
Deduction appraved in Ure amount oE
20 20 20
Sigranne d counry a�annr
( I I We certify uMer the penalry of perjury that the above arnl foregoi
owner I contrad buyer of Ne aforemeMiwied property on date appli
Sig�ture (oivriers fiitl rne) _
r.�'� r.�- �
Fuil resitlent address �of appliranl (riumDer and stree4 �N �te, anA LP ootle)
'�1�2� i�iS�S
A�ress o( auCrorar� person (numberaM stree; dry, srate, antl LP coda)
PJ!i,_2�U �d ��
What Tamg D'strirlT
UNTYAUDROR
�Is property in quesGm: Mnua�y Pssessed
Rea�Property ❑ a.nnuanyassessed
Has Na tlr�uction Deen requestM on popMy
for wemnt SzaY? ❑ No
❑ Yes
D1':11V'CI" �'�. � O� � ........
S
Card NO. ... �.°....�.n........
20
�Y 3��
�ident at InGiana aM
�y Y�e�