HomeMy WebLinkAboutMortgage_Vermillion"'n 5TATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS un Township Year
__ s FOR DEDUCTION FROM ASSESSED VALUATION IO
� Stdte Fotm 03709 (R71 / 6-09)
�' Pr�m�bed by Departrtc'ri W Lo�l GwammeM Frw¢e
File Mark
INS7RUCTIONS:
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To be lled in person a by maii wiM the CowtyAud'Rw or Counry Recorder o/ the county wAere the pmperty is bcated.
Fi!"mg Dates: 1l Real Pmperty: Must file durirg fhe year /or which the deduction is soughf. Counry Auditnr
2) Mobde / Manulactured Homes raf assessed as Real Properry: Must file dunng the nveNe (72) months � �� /{�/�
beto�e March 31 of each year the deduction rs srought , acfqunryHEWrtler
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See reverse side 7or addifioqel insLUCUons and qualficatiau. GI
see
.4ssrssed vahie of Rai P�P�Y � �
Mad� 1, arrrlR year
tt ro. whal s tus I her euG share Of Nterest?
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Contraa inde6tedn�s unpaiE az ot Mw
irte�rt yeer Eab
tt narne on remrC e Srtfu�t Uun Ihat ot aPP��t �dibte below.
m�ngagea «
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Name of assi9nee w othu owner or hdder of morigage
AdE�ass ot assi9tree (numbar aM snee; cay, slate, antl ZIP code)
oces epd��� am propeity in arry an«
mumy in Intlana? ^ ' _
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t'�
H ownetl
LP mde)
Remrtl numWr
unGaiC a d Is Ne
_ _ � �
someorre dher ihan spou.u.
Yes LJ No
Is Ihe property in Qurstion: MnuaDy Assessetl
� Real Roperty � MnUallyAssessed
Moble Home (IC 6
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— - — �COUNIY AUDITOR
Dra�ver NO.,.s�0��.......
Card.NO...:.�591 zo zo_
. ���qY09. � ���
1/ We cerOfy untler me ye��a��r ... ,....�_., _... )oing infortnation is We and mrtec2:
owner / mntract buyer of ihe afwemerrtioned property on date application is filed.
�na¢� (o�xieh hA ^?rji . �
Fullresihentaddress�i(aDM���MumberaMSbeet,city,slate,andZ/P000'e) L����
(� aoCo 5• l7 �� f-r P,,�c.a,Yc.Y, I hl
Pe�SOn auCrotaed Oy duly esecvttd Power o(Attaney or �y IC G7.1-12-0.7
state, aM LP mM)
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