HomeMy WebLinkAboutMortgage_Hamilton_"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Counf
_ : FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Form 03709 (R71 / 6-09)
��«. � Presv�tetl M DeGartmeM of Lacal Govemmer�t Frunce
INSTRUCTIONS:
To be fiied in person w by mail with the CountyAudito� or Counry Recorde� of the county where the property is located.
Frfing Dates: 7) Real Property: Must fife dunrg the }rearlor which the deducGon is sought
2) Mobde / Manufactured Homes not assessed as Real Properry: Must file dunng the M1velve (12J months
betore Malch 31 0l each yEar the deduction is sought.
See reverse side (or addifional insVUCtlons and qualifications.
Appfrcam (owper or cpnvact buyer - sqe rest�ij!'ons m reverse $ppe)
Tating
7 va4ie t( mal P�' as of
ar'art year
ra, what
name m
Name of rtrongagee a mntraU seller
/
rtMi�ate bebw:
qoaress m rtqrtgagee or mnuaa seuer �numoer am swe� wy. �ce.
Name of assuFee w oNU owner or haWer M mortc
Mtlress ot a55ignea (number end 5bee; dry. Stete,
Does epplifant ovm property in any other
�� �� i�c��
_ ❑ Yes ❑ No
DeducGan approved In tlre
�ttr�(guditnr
Counry Recorder
nuoiroR
1 as of Mwigage / ContraG'vWebteAnrss unpaiE as d Is ihe eppimnl the sole
date of eppfifatim legal or equitade oxmeR
❑ Yes ❑ No
If owned wiM someo�re oiher than spouse, Indkate with whom
Is iM propelty in v�^: A^nua�yltssesud
�2eal P�oPertY ❑ Armua��Y Assessed . : _
u yes. whac �n�nyr � wna�
AUDROR
Di•a�ser \�O.a v � �i —
.....
CaCCjy$��r�. ,/,� (c U
" / �f.S �a .......... �xm
, 9 sti o No
20 20 _ 20 _ 20 _ 20 _ 20 _ 20 _
Sig�aWre ot Counh AW itor Counry Da�e (monM. daY. Y�/)
I/ We certify under Ne penalry of perjury thal Ne above and foregoing infortnation is true and mrtecl and that the applinnt is a resident of Indiana and
owner! mnVacl buyer of aforemerrtioned pro0erty on date application is filed.
�'?faN Is (u0 narm�re) Date (rtorvh. EaY• Y��
T ,�nii��. / /yh���:,^ !o%(i�ZuOS
P autho'aed Gy duy executed Power o( AnorneY a M IC bt.t-12-0.7 I Date (monN. EaY. Y�� �
Address of a Wv'¢etl pelsm (numberarM sbeet tlry, sbta, aM LP code) .