HomeMy WebLinkAboutMortgage_Chamberlain (3)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ - FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fortn C3709 (R71 / 609)
S � Prgaibetl by �epartment of LnW Govemment Frence
F'
INSTRUCTIONS:
To be filed in person or by maii vrith the CountyAUditor or Counry Recorder o( the county where Ne propeRy is IocatedJ U L �
Fi7'mg Dates: 7) Real Property Mus!!de dunng Ne yearlo� which the deduction is sought. County Auditor
2) Mobde / Manufacfured Homes not assessed as Real Property Mus( file dunng fhe hvelve (12) rtwnths
6e(ore Ma/ch 37 o(each yearNe deduction is snught. �p-y�,(, �,n-�County Remrder
See reverse side f�r addiLOnal instnictlons and qualifications. ' " J J___
������
1. bx�art year
II no, what a his / her e�act share ot interest?
If �wne m recwtl a C'dferent than Nat of aPP��t mdicate Eelo�r.
�o-m� ar,a-oa.s ,�,�� r`�`G'�
unpaid as d Mortgage / Convari cWehteEnnss unpaiG as d Is Ne epd�� �e sole
� Eate of appliration legal or equitaWe ovmeR
❑ Yes ❑ No
If ovmed wiM mmeone aher Ihan spause, i�i�te with whan
Name of mortgagee or cono-act seller C � `. r�- -
( �1
Pddress of nwrt�agee w con
Name o1 azsignee w oNrJ w
lll':111'C1' �'0..4fSM!�!.l. ' —
PAtlress ot assignee (numDer • • . • . ..
DcesevWitantownWnPanY� �,':11�C� �iO �^�CJ�� uar
munryinlrWana? C ..........
��I'I �.......
, SCb. � -
GOUNTYAUDROR
20 20 _
p t AuEi r
i/ We ce"fy und e penal
owner I mnVacl r of ihe
20 _ � 20 _
the above and foregoing informaGOn
property on date application is fiied.
m by IC G1.142�]
Pddress of auUior'vsd persan (number aM sbeet, dry, state, a�
�
Is Ihe P�Pert1' in Vuesiion: MnuaOy Assessetl
❑ Real Property ❑ Armualy ASSessed
Has Nis dedutlion Deen requeste0 on O(operty
far cu�rent yea(.� ❑ Yes ❑ No
20 _ � ZO
oa�e
and cortecl and that ihe appiitant is a resident of Indiana afxi
�Y. Yge�