HomeMy WebLinkAboutMortgage_Fuhs^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
: = FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Fwm C3709 (Rt1 / 6-W)
�' � Presaibed Ey DeP��M of Lowl Gwemment Firence
INSTRUCTIONS:
To 6e Fled in person w by mail with the CountyAUditor o� Counry RecoNe� 07 the counry where the pmperty is located.
FiNrg Dates: 7) Real Ploperty: Must fde during the }rear for which fhe deduction is sough[.
2J Mo6Be / Manufactured Homes rrot assessed as Real Property Must file dunng the fwelve (12) months
6efae March 37 07 each year the deduction rs sought.
See reverse side for addifional instruclions and quali�cations.
AnoGa9N (ouirer orconvaU buver- sseleslnrlqns m reverse sidrYl .
=�ai�=°�ro �-�o. 3a �- v a� � R���
'n4a6e / Contraa'ude6tetlness unpaid as of Morigage / ConSaz1 uWebted�ress unPaid as d
�
11 no, what Fs his / her e�ct
Name oi mortgagee or contrarl seller � I �
Address W mortga9r� m m�trect se0er (nwMer aM strae4 ��3: state. eM LP codej
Name af assignee or oNer owner or hdder ot rtvrtuage .
AAdress ol asvgnce (numDer end slree4 �#Y. s -'
Dces epplimnt awn property in any oNer
munry in IMiana?
❑ Yes
DeducGm appm�.ed in Ne amoun[ ot
Year
Audiinr
Yes U No
someone o�her than spouse, InGiqte wM wi�om
Is ihe property in purstion: Mnua%ASUSSeO
❑ Real Pmperty ❑ lvmually Asse55ed
hbdle Hane (IC G
Dra�ti�er NO..,p�(��
, •• •••• Has Nis detlur�on been re9uested on pmperty
tor curtenf yeaY.+ � Yes ❑ I
Card NO. .....Jr, �Jr9 _
__
��37,vGy °°
20 _ 20 20 �u _ 20 20 _
Sigruture d Caunb Auditw Cwnry Date (month. daY. N�/)
I/ We certify under the penalry of perjury Nat ihe above antl foregoing infortnalion is We and correct arW that Ihe applinnt is a resident of Indiana arM
� ow�r yr I contract buyer of the atorementioned properry on date appiicalion is filed.
�e (owrw�/l fiN nartre) � I Date (monfi, daY. Y��
e'9
stare,
1uty exewted Power oflUt�rney rn by IC 61.1-12-0.7 I Date (manlh. day, yea�
person (number arM sbce; dry, state. anG ZIP code) . -