HomeMy WebLinkAboutMortgage_Swader"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
: FOR DEDUCTION FROM ASSESSED VALUATION
� — . � Sbta Form C3709 (R71 / 609) � � ✓
S,,,. Presaited br ��� d La�vl Gorertunera Rrence I
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INSTRUCTIONS:
To be fifed in ��i� e� s �� �:
person or by mail wiN the Counry Auditor or Counry Recorder of the counry where the pioperry t i�
Filirg Dates: i) Real PropeRy: Must file dunrg the year /o� whicA the tleduction is soughG � Counry Audimr
2) Mo6ile / ManufaGUred Homes not assessed as Real Property: Must file dunng the Mzlve (ltimonfhs � �nty Recader
6efore March 37 0/ each year the deduction is mugh[.
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See reversa side for additiunal instruq(i�s �pd ualificalions. �/ V ___
nsmre�ersesaYe) � v�u.�v� ........... ..__'--
rnxnber / kgel tlesvi ' Remrd number
�,lp - l9-(�/�/ -�o/. /s.s - o �. � o'jO�o
Marth 1, anvtt ym �Y as d Mortpape �� hteEness unpaid as d �MOrtgage�� 'videbtedrres5 �m7� as d'�
Rili /'� DOD
I( iw. what Fs his I her eraG sha�e Of interest?
Ii rwne m remd s Qrtturnt Nan tlut W aPP��t trqKate oela�r.
Name of rtwrtga9ee or mntract seUer � �
Addrea of rtnrqa9� ar contraC seDer (number and saeeG �Y, 5ate. arN ZlP mde)
Name ot assignee or other wmet or holder of rt�ortgage
AGCress of atignee (numb a`�ary, state, entl LP ode)��
Oces app'imm wm poperty in any other I( yes, wha[ muntyt
munry u� InOiana?
❑ Yes ❑ No
coun
Drau�on apryo.�ed'vi the amouN al:
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Signatlue N Camb Auaitar
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avmed wiCi mrtmro
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Wl�a� Taa� Datr�1
�AUDROR
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sPOUSe.
Y� u No
Ihe property in Ouesiian: Mnu91' Assessed
� a�v�env ❑ amuanras�essea
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Dra�ver NO...:??.L.��..�rl.......
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. I! We certify u��the penalry ot perjury�fat Ne above arW foregoing infortnalion is We aM cortect arid Mat the applinnt is a resident W IrWiana aM
avner I contraG uyer of the aforementioned property on date application is filed.
`' Slgrature (owneh fiN nama) � Date (nimN. deY.Y��
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ME� d autlra'¢ed 7e� (numberand sbeeG �: sfafe, antl
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