HomeMy WebLinkAboutMortgage_Young (6)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ = FOR DEDUCTION FROM ASSESSED VALUATION
• ' State Fortn A3709 (R11 / 6-09)
� � Presai0etl by �epartmem of Laal GmiemrtreM Finance
wsrRUCnoNS:
b 6e fiied in person a by mail wifh the CounlyAuditor or County Recwder of the county where the property is IocateP
Fifing Da[es: i) Real Pmperty: Must file dun�g the year for wbich the deduction is soughf.
2) Mo6�7e / ManuFadured Homes not assessed as Real Property Must file during the M1velve (72) monfhs
6efae March 31 o/each yearthe deducfion is sought.
See reverse side (or addifional instructions and qualifications.
MP�m( orcontranbuyer-3PeresLicti°nsp'/�verseside)
O (o—� �'� _l
ed vdue af mal yoperty as of Mortgage / Conbaa
7. wren[ yCM Ma'� 1. wrten�tyg/
GJC �
Ihat Is his / hu euU sliare of interest?
: m�eooN's EiRerem than that at aGP�t'mGi�te below.
��m
of mongagee «mntrad
T^ I Name of assiry�ee w oNer owner or halder W mortga9e
��.
Atltlress oi assignee (numDer arM shee; cdy; state, arM Z/P cade)
Oaes apptiont own property in any alher I( yes, what county7
counryinlMana? � �
�
someorre
What Ta�a(g D'striG?
ILED
�Counry Auditor
Counry Recorder
Page numbrl
iMe6teE�ss unDaid as d Is Ne e0d��t fhe sde
legal w �quitaNe axneR
n Ye5 n No
Is tlre propeny in Qursiiw� MnueOy Assessetl
❑ Real Roperty ❑ ArmUally Assessed
Abble Flome (IC 6
Nis deduGim Oeen reQuested an P�PP+�Y
urtentyear? ❑ Yes ❑ No
COUNTYAUDROR
Deduction app�wed'c� tlie amaum oF.
20 20 20 _ 20 _ 20 20 20
Si9iaMe ot County Auditor Camry Date (rnonth, OaY l��
I/ We certify under the penaly oi perjury that Ne above aM foregoing infortnalion is W e and correc[ arW Ihat the applipnt is a resident of IrWiana a�
owner I mntraa 6uyer of Ne af«emenlioned property on date applicadon is filed. �
roW (o e/s fiN na Date (�, day, yva�
F� aEArnss U ppfmant (n r anE a,spte, and LP a
y�
PasOn auNa'sed Oy Wy esewted AltoeneY a bY IC 67.7.12-0.7 Oaie (mcnM. day, yEe�
Atldress M authvaed person (numDer arM street ary. sbte. end LP code) .
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