HomeMy WebLinkAboutMortgage_Austin"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C n 7own ' r
:_. ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn C3709 (R71 / 6-09)
�' ,,,, f Resaieea q DepartmeM w lnw covemment Fnanca
OC�a
INSTRUCTIONS:
To 6e lled in person or 6y mail with Ure CounryAuditor or Counry Recortler o7 the county where the property is bcated. F� �� �/��
Fitirg Da[es: 1) Real Property: Must fi/e durirg 1he yrear for which the deductbn is sough[ �o ditor
2) Mo6ife /Manufactured Homes iat assessed as Real Property Mus! h7e dunig the fweNe (72) months
befora Malch 37 oteach yearthe deduction is saghG GIBS N� �N�C���i?����
See reverse side 70� addifional instructions and qualifications.
�ow,reroroonvauquyp,�'seere.wirayfsm2�ersesiie) ^ � '
_,
������ ��e,���
Mamh 1. amnt year Mard� . a�rten%t year
� —I! �
rc�o,�on�sine���or��,�c? '
tt name m remd'e Qfterent Nan ihat o( appOtanl, hiArc�aoe Gelmr.
xtgagee «mntrau seue
rtiortgagce or canbacl u
sia�ea w oN� wmer w
shee4 <+N state.
JL.t.'uL
ray. sfafi. entl LP cotle)
Reeofd number
o - ooa. oia -o �s— o�c
i�s unpaid as of M�xigage / ContraO mdehtedness unGaid as of I
tt owned wiN someone othar ihan spouse.
�
kgal w epuitade on�rre(.+
❑ res ❑ No
whorn
perty in Ouestia�: MtweOy AsesuE .._. I
RoPertY ❑ArmuallyASSe�ed �
Dces a�itant wm praperty in eny athu If y�s. what wunry? NTat Tadrg D'¢viri? Has Ih¢ deAxtim Ocen requestetl m proprity
munryinlndiana? ❑ Yes ❑ No _ /orwrtemYnaR__.—.— -.—.—�'
couNrvnuorroe Dra�ver 1\TO..,./�..� I �
D�uaion approved in Ne amount ot ��� �
zo zo_ zo zo_ Card 1�'O. y���
Signature N Counb Auditur Caunry � I�� i� O�•�
� \
I I We certify u the penalry ot perj that the above and foregning infortnalion is We and cortect a�d t�at Ne appt'innt is a resident of IMiana aM
ovmer I mntracl buyer of ihe afwementloned property on date application is filed. �
state,
Pelson auttv�d Ey dury e<eaitetl Power NAttorney w Cy IC 61.
ea
Addmss of autlwtired persan (number arrd sbee; ay, state, and Z
�7���
Date (monfh. daY. )ea�