HomeMy WebLinkAboutMortgage_Mayer (2)^`� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
a FOR DEDUCTION FROM ASSESSED VALUATION
:r=_" . " State Fortn d3709 (R71 / 6-09) �
�` �.. � presvib¢tl py Departmenl of Local Govemment France
°" \� File Mark
INSTRUCTIONS: � F� �� �:
To 6e frfed in person or by mail wiN the CounryAuditur o� Counry Rewrder o! the counry where the pmperty is located.
Filing Dates: 1) Real Pmperty: Must fite dunng the year (or which the detlucfion is soughG � County AudiWr
2f Mo6r7e / Manu(actu2d Hortres rrot assessed as Real Property Musf file dunng the hvelve (12J monfhs
6efore March 31 of each year the deduction is soughG County Recorder
See reverse side 7or adtlitbnal inshuctions arrcl qual�cations.
MP�nt(px+�rorcaitracf6y'er'���tri�o�+s�^reversesiCe) 1
�..r,,:ft.T.��i�i^5
If no. what is his / her e�or� :1ta2 of intrsesl?
=%�09-3�0o a
�.1��g e/ Contracc irdebteOness unpaid a N
March 1, wrtent yeer
m�ew�d is diRUent Nan ttiat of aPpGqnt,
of rtrortga9ee or mnvaU
Address of mort9a9ce or canbact sener (numDU ana sn
Nama ot asvgnee w oLrer awner or hdder of mortgage
naaress
street �l: state, antl
ciry, state, arM ZIP code)
0
somea�re
R¢mrtl number � Page numGu
btedness unpaid as d �s Ne epplkant
�eg3� a epuilaW
❑ Yes
spouse. irdirate wtth wMrn
No
Is Me property in quesUOn: MnuaOy KssessN
�eal PruPenY ❑ ��Y �
Mob�le Home fIC 61.
Dces e�ifant am pmperty in any oNer I If yes. what countyt I Whal Tari�g DisGid9 _ _
couiLLy in Ind'ana? ❑ Yes ❑ No � �� .
'o
a01�...••••• _
COUNTYAUDROf yo:..�••�•/' _"
Deductim a„mved'm ihe amount o,: Tlr a.v er ' •� n/� {.� !
l� �..� �
20 20 20 20_ r .d�O� ,..•'�'�•• �R �e�w`�' �
Sigreture W Camb AuOitw Caunry �+aC� _� y e
7 •
� ^ ^ pr �'
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I I We certify under Ne penalty of perjury Nat Ne above arW (oregoing infortnaUOn is We ai ...y�r�cant is a resident of Indiara aM
owner! contrac[ buyer of the aforementioned property on date appiicatlon is filed.
c:�n�n�m Inwwls fiAl �rtrel Date (monfh. daY• Yaa�
FW
(number antl sbeet, cRy, stata,
Gy duh/ esewced
7
ot authwaed persai (number arM street, ciry, state, and ZIP cotle)
�
(mnnfh, daY. Y��)