HomeMy WebLinkAboutMortgage_Reeder^�� STATEMENT OF MORTGAGE OR
__.,. FOR DEDUCTION FROM ASSES�
� • Stale Fwm a3709 (R71/6-09)
S,µ � Pr¢saib¢tl by OepartmeM of Loral Govemment F�anu. � U L 2 0 2012
�JSTRUCTIONS:
To be filed in ^ � �—
person w by mail with the CountyAuditor or Counry Recorder of Ne ceunly ioperty is focated.
Fiimg Dates: 1) Real Pmperty: Must file during the year (or which the deductionA �is� sought. g
2) Mo6de / Manulactured Homes not assessed as Real Piop�rb:S ON CO U N T Y AU D ITORZ� months
before March 37 of each year the deducfion is sought. � a
See reverae side for additional instructions antl qualifications.
�Y
�,•er,:acr.^c:.:a
II no. what a his / her e�ct
on rem�tl is CAterart than ihat af appficant, uM'vare �ebw.
I rtrort�agee a mntraG seDer � ,� _
ACdress ot rtprtqagce ar mnbacl
Name al assignee w att�u wmer w
Addre�^•_- -
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C�ld�O• ••••••••.
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I I We certify urder ihe pen�lry of perjurylhat the above ard�ore
owner I conVact buyer of Ihe aforemenlioned property n d��e a�
( /s 1W+�a
!
y0 r�etitlent o a t(wmDerand a; state, an ZIP ooa
JO R� ��✓s�- i ,1
Person aufhaaetl Cy Cuty exewted Power of Aitomey w by IC G7.1-12-0.7
Pddress W autlrorrzed person (number antl stree; dry, sbte, and ZIP oode)
File Mark
Fortn f�ed wiN:
County Audrtor
County Recorder
�.b���0�� � ��� i�J
1 a af Mwtgage / CanVacl mtlebtedness impaid as of Is the appdrant ihe mle
y�� Eate ot avP��� legal w epuitade v�.neY!
'(/ ❑ Yes ❑ No
If ovmed with somewie oiher Man spouse. udicate wiTh wtwm
.�a.irr: r-ian a � c.1:�
20 _ � 20
Counry
�$ (�C p(Op2lly N QIIPSIIM: iY1f1U3%A�565C�
❑ Real Pruperty ❑ ArmuallyA55essed
Mohile Home fiC 61.
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'�r ❑ ves ❑
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l.zsra
20
intormatlon is W e and cortect arW Nat ihe appiirant is a resident of IMiana and
ion is filed.
Date (+ronfh. daY. Y�A
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