HomeMy WebLinkAboutMortgage_Johnson (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
,_._ FOR DEDUCTION FROM ASSESSED VALUATION
• Sfa[e Fortn A3709 (R71 / 609)
��.r l Presaibetl CY DeP�nl o( Local Govemment Fu�ance
File Mark
�srRUCnoNS: � �
6e filed in person w by maii with the CountyAUditor or Co�nry Recorder o/ the counry where the poperty is locat �u :
Fd"mg Dates: 7) Real Pmpeify: Must file durirg the year for which the deduclion is sought. ditor
2J Mo6ile / Manufactured Homes rrot assessed as Real PropeRy Must file dunng the fweNe (12) months
befole March 31 o(each year the deduction is soughf. FE ❑ Counry Rewrdu
n
See reverse side (or addrtional instmcGOns and nual�cations. •�
AppGra t(owneror buyer-see mreve side) C.J.
�- r
TaAng Ois ' Key rwm0er / al desaiP� � e numbcr
GIB ��"�Y q DI R
a - -�ccn3 oa�
ralue oF 2al P�G�Y as W Mor[gage / Conbact iMebtedrress unpaiA az U Mortgage I Contrerl cMebteM�S un0�7 as of Is Ne aPP�^t Ne sde
AWrh 1, a�t �ear Marri� t. /a'irrent year Cate o( aPP�� � w�� �
N �!////� ❑ Yes ❑ No
II no. w�at a Ifrs I Mr erarl share of interest?
11 name on r¢<py is dfterent ihan iha� o( appG
Name ot mortgagee « mnUaG selkrc�
It owned wiM someorie dher than spouu. ir�difate wVh whom
Pdtlress of tmt�agee or tontiatt seqer (numbe� and.snee4 taY, sbte. aM ZIP cade)
Name of assgnee or oNer owner or hdder ot mwtgage
streeR a+Y,
Ooes appl�nt am property in any
munry in Indena? r� ..
Dr�ucUOn approved'ui tt�e artaunt of.
�
Sigranne W Counb a�Cilcr
IP ootle)
yes. what m�nty?
� n,., . O �/ couNn
20 � 20 � 20 _
Ihe 7�G�Y in QuesUOn: MnuaM Assesud
�a� Roaero � M�ualNAsse�ed
a���.........
]�C�\\'CI' \�.......
. i n
C:il'(i t��. ... W.�........
��l�,Ira.�
� LU_ I ZO_
Caunry
Da1e (monN. daY.Y��
«� mocPm
�
I/ We certify under Ne penalry of perjury that the above and foregoing infortna6on is We and corteG and Nat Ne applicant is a resitlent of Indiana aM
owner / contracf 6uyer of the atorementioned property on date applicalion is filetl.
of aPAfraPt (qumQer qnd shee4 tlry.
exewretl
�
61.'
P4tlr�s of auNarzed perswi (number aM sfree4 �: sfafe. antl ZIP mEe)
(rtronlh. tlaY. Yea�