HomeMy WebLinkAboutMortgage_Luttrell""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7own hi vear
_ FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn C3709 (R77 / 6-09) �
��u. � P2ulibed Ey �epartmeM of Loral Gorerrunerit Finarce � !
A � � File Mark
INS7RUCT10NS:
To 6e filed in person or by maii wrth tAe CountyAuditor or Counry Recrolder o/ the counry where the property is located. �� �
Frfirg Dates: 1) Real Property: Must file during the yearlor which Ne tleduction is sought.
2) Mo6ife /ManufaUUred Homes rrot assessed as Real Properfy Must file dunng the hvelve (12) months _
befole Marcfr 37 0/ eacA year the deduclion is sought. �
See Ievarse side for addifional insWUfons and qualifications. ._ �,,,
tt narne
C/�ounty Auditnr
C5wty Remrder
V _'..
Key rnimber / legal tlesaiption Recoid number Page numbu
, - -io -oo �. -oa � aoiU 53
poperty as d Mortpage / Contrarl inde6teErress unpaid as o( Mongage / ConYact indebte0�xss unpaitl as af Is Ne epplirani the sde
Mam3� wrtent yeer aace a apprKano� kgal v e�ryritaNe awm(?
❑ Yes ❑ No
e.aa share a intr�t? rc ownea wlm someorre mrer mao sro��. Ndirate �r.tm whom
Name N rtqrtga9ee «mntra<Y seller
naares w rtnr¢�agee or mnuaa seuer lnumcer am snee4 wY. �ta. am ur 000e�
oiher mmer or halder oF mortgage
(numbar eiM stree4 my. s+ete, and
Dces ePWinnt ovm propeny in any oNer
munty in Indana?
❑ Yes ❑ No
Deducfim aGW� in the x
�
Signanne W Caunb AuOnur
�
�
�� waPenv in Question: nnnually wssessed
Real RoPertY ❑ ���!aM�
Df a { 1'L't' 1�'�
Ca�.� 1`� �Q��, .
9s �' • .
� , yc�,� `�3�
�` �i � .
=Kd9'`'C COUNTYAUDROR ���" /
20 20 _ 20 _
Counry
20 — � 20
Date (rtaNh. tlaY.
I/ We certify under the penalty of perjury that the above arW toregoing infortnation is We and correct arW Nat Me applipnt is a resident of Irdiana and
owner I mntract huyer ot the aforementioned property on date application is fiied.
I��S,(o�merslu9 �� Date(nwRh.daY.Y��)
FW
tity, state,
Puson autlnfaed by tluy exeated Power o(Ntnney or Cy
ACtlress of ainhar'¢ed person (numberarM sbee( tlry, sfafi, antl LP code)
3n/ c/ 76 4�
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