HomeMy WebLinkAboutMortgage_Hoke_^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
FOR DEDUCTION FROM ASSESSED VALUATION
'� �• Stata Fwm C3709 (R71 / 6-09)
-� yw � Prgaibed by DePartrtrent of Laol Govemment France
n STRUCTIONS:
To be filed in person or by mail with fhe CountyAUditw or Counry Recortler of the county where the pmperty is locate¢
Fiiirg Dates: 1) Real Pmperty: Must file during the year (o� which the tleduction is sought.
2) Mo6de / Manuledumd Homes lat assessed as Real Prtiperty Must fife during the twelve (12) months
6e/ore March 37 of each year the deduction is wught.
See reverse side fw addifional instroctions and qualifications.
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�g=:�y_cxJO.-�y /- o
/ ContraU iMe6tedness unoaid as of Mortgaqe I
Ma� t. aare�rt Year I mami } curtenc 7rea
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((/C�J�.:�l
�( ro, what a his! her ezar� share ot interest?
If fwrie on recoftl's dMuent Wn that of appfiant, h+Airate bebw.
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Address of mortgagce w contract seAer (numMl and sN,�C ciry. state, aM ZIP wAe)
Name o1 assi�ee w oiher ownar ar naaer ot mortga9e
Mdress o( assi9nee (number and street ary, s+ete, eM ZIP code)
Oces aPd�t wm properry in anY oNer If yes. wh:
Ta�d
�
-�
Year
30
County Auditor
Counry Recorder
Remrd number
I 6 73
Is Ne epp0�snt the sok
legal w equitade ovmeYi
❑ Yes ❑ No
IIs C�e pm�tY m Guestm. Mm�aP/ A•.sesseE
❑ Reel Pfoperty ❑ � AS5e5sEd
Drawer NO... �� � �a —
Card iti'O. ....U,.7J
� �i C�� �%C) . � .. .... . . . � No
T� "- COUNIYAUDROR
ducUOn approved a� ihe amount ot
20 20 20 20 _ 20 20 _ 20 _
�(uwre ot Counb Auditor Counry Date (monM. daY. Y��
1/ We certrfy uMer Ne penalry oi perjury that the a6ove aM foregoing infortnation is W e and mrtect arM that the applicant is a resident of IrWiana and
owner % wnVad buyer of the aforemer�ionead property on date appiication is filed.
.........e,a..��,. nn,.�,..ei �TI /'1 oate (monrh. daY. Y�aA
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Person auUror¢ed �y duly executeE Power o(AttaneY m M IC G7.1-12-0.7 � I�� (��. �Y
Pdtlress of auVror'ved person (number arM streef, dry. stale, arM ZIP oode) .