HomeMy WebLinkAboutMortgage_Lambert� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ _: FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn d3709 (R71 / 6-W) ,
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File Mark
�NSTRUCTIONS:
To be fileU in person w by mail with the CountyAuditw or Counry Recorder o( the oounry where the property is located. F� fl� ��
Filing Dates: 7) Real Pmperfy.' Must file dunng the year (or which the deduction is sQ4gyt. ^f �(j �� �unry Auditor
2) Mobde / Manufadured Homes rrot assessed as Real PrtipeAy Must4fk Flurhaj the`Iwe (12) monfhs
6etae Maich 310! eech year fhe deduction is srought ❑ Counry Recorder
C.'J.M.�.y _ _ —.
See reverse side (oradditional inshuctions and
Pno6ranttawneror ahuver-seereshirlionsc
Key
assas�a � ar � aw�r as a
Ma�U t, armnt yrar
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Ii no. what 6 Ns / her e�ct
rume m
Name of mortgapee ar mntraG seiler
PLdress of tmlgagee or mntracl sPAer
Name of assi9nee or oMer owner or
Aaamss ot assignw (numoer
Dces apptimm ovm ryopa
counry in InE'ana?
Detlucem approved'm
20
Sig�Me N Camb A�WWitor
Monpage/
Mart3i 1, q
COUNTY
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Unpaid as of Mortgage / ContraC i�Web[edrress unpaid az d
data ot appGmtian
�er and stree; 29y, slate. arrd ZIP code)
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stare. antl ZIP mtle)
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WtatTari�g DisGia7
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is Ne app6rant Ne sde
legal or eQUilade wme/7
❑ Yes ❑ No
otMl tlun spouse. iMicate wiM whom
Is Ne V�Ge+b in Vuestion: MnuaDy AssrsseE
❑ Real RoPeKY ❑ A^^�Y �
s IhiS deduttian been repuested on O�opertY
W��� ❑ Yes ❑ I
� � zo
I! We certify under ihe Denalry of perjury that the above and (oregoing u�tortnalion is We and cortect and that Ne applirant is a resitlent of IrWiana and
owner / mntracl buyer of ihe aforementioned property on date appiication is filed.
y�aWre(ownafsM1Anam� �� Date(rtmfh.daY•Y��)
d appGcant (number antl slreet. ary, sfafe, antl ZIP cw
E, gov S. F�� B�,
EW ezecutetl Power d Altomev w Dv IC 61.1-12�.7
MCress of autlmr'ved person (number antl sbeet, dry, stafe, and LPOOde)
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