HomeMy WebLinkAboutMortgage_Loney"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fortn d3709 (R11 / 6-09)
�' Presaibetl by Departrt�enl 01 Lasl Govemment Frence .
INS7RUCTIONS: -
70 6e filed in person w by mail wifh the CountyAuditw or Counry Recorder o! the county where Ihe pmperty is bcafed. S
Fifing Dates: 1) Real P/operly: Must fite dumig Ne year for which tha detluction is soughf.
� 2) Mobde / Manufaclured Homes nof assessed as Real PropeRy: Must fiie dunng the hveA�e (72) months
6efore March 37 ot each year the deduction is swyht `
See reverse side (or additional insVuctions and qualifications. _ �
Apamn�.{q�yyerwcqrtrarJbyrer- re � m/grersesiie), GIBSO�
AssPSSed vahce of mal qaperty as d e/ Cont
n�a, i, a,�a year �,�, �m
II no, what a his / her e�d share ot iniemst? � '
tl rame m remtl's Eitterent tlwn Mat oi aOpOCan1, hid'uate bebw
Name ot rtuutgagee or contract seqer
Address ot �ratga9ee w contrad sell
Name of ' ee w other ownet or h
stree4 �: ��.
� �VOC�O �
az ot Monoaoe / Conrafl indebtedness
Caunry Remrder
I tlate of aPpfxation I legal w epuitade ame%�
❑ Yes ❑ No
Ff ovrt�ed vriN sameofre aher Man spouse, IMicate with whom
Is Ne property in 0�: A^nuaDy Pssessed
❑ Real Rovertv ❑ ArmuaM Pssessed
ass� .._,._...... .n..n' �
AOCrea of assignce (numEer and stree; rity. sfat— � V
Does appikaM am propeM1y in any oNer O A' � v ��`�� D —
tounry in Indiana? � �� � „
❑ Yes ❑ Nc 1 <
J
Deduction aGP� 4� Ihe amouN oF. 6 1� /��/` 1
Has Nia dedutlim 6een requr5ied on ptoprity
for turtent yean � Y�
❑ No
20 20 20 2tl _ 20 _ 2f1
SignaW�e W CounN AuOitcr Caunry Date (rtronN. daY Y��
I/ We rtify under Ne penalty of perjury �hat the above and (oregoing information is We and correrl and that Ne applirant is a resident of IrMiana arW
own ! buyer of the en property on date appliption is filed.
( hA Date , daY. �
as a� 9
F W et. ' .antlZlPoode � �^���
1
Person a by dtdy esecuted Power of AvaneY a bY IC 61.1-12-0.7 � �� (^���, �Y• Y��
ACdress of a WnrvEE person (numberarM stree; dry, slate, aM LPmde) .