HomeMy WebLinkAboutMortgage_Vessels"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
: FOR DEDUCTION FROM ASSESSED VALUATION
Stata Foim 03709 (R71 / 6-09)
�' � Presrribed by DepaRmeM of La�al GovemmeM F�anca �
File Mark
wsrRUCnoNS: ^I(�� 1
To be fiied in person a by mail wiN 1he CounryAUddor or Counry RecoNer o1 the counry where the property is bcAi�t/. ° I�'
Fif'mg Dates: 7) Real Propeity: Must file duriig the year for which the deduction is soughL Counry Auditor
2J Mo6Ae / Manu/actu/ed Hanes not assessed as Real Property: Must file dunng the lweNe (12) month �y'� �� R��
belwe March 37 0/ eacA year the deduction is saght. ���� �a� tY
See reverse side foradd " ins s arM qualificat s. //
� , �" fl�gaoN COUNTY AUPITpF
Appfrant(mmerm Duyxr- .�s,a'LR n � _ ..
i real popMy as M
1�
l�
Name of mutgagee ar conttacl se0er
desa�tion
Mortuaqe / ContraU
Mard�7.a�rtenivel
Deiow
Add� of rtartqa9ce or canvaa u0er (numDei end stren+- rr,.. m�
�„e � �
�� � V f"s sd,S
�d�of: p�A�.�,� m vc;ss�s
,
�a,�;� o1D/U -S`�D S
courLLy in In0
Dr�uaion approred in Cre amount af:
20 20 20
Si9���2oiCam tlito
I/ We certfy uMer Ne pe alry ot perju that the above e
awner I�ontract buyer M the �jorepw � d pmperty on
Pa«er al Atmrney dr by IC 67.142-0J
Addr� oi aW�orvtV Derson (num6er aM sbeeC �1: sbte.
i 9-i� 3 dl��/ iTa
Inrs9 unpaid as of MoRg3ye I ConNact
�,.�n � � date of appGntion
NTet T�d(g District7
iuNTYAUDROR
20 20
Reco�d number
w e0���ble ovmM
❑ Yes ❑ No
xTwm
b tl�e D�M+h in 7ues6on: MnueOy AssesseE
❑ Rea� ProPertY ❑ Nmualiy Ases�
:tea m propPlty
Yes ❑ No
20 — � 20
I Counry </��� Date (/nmlh. daY. 3��I /`/�
b /
infortnalion is We and cortect aM Nat the applicant is a resideM of IrWiana and
ion is filed.
Date (monlh, day, ysa�
S,f/, 4� �C y �
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