HomeMy WebLinkAboutMortgage_Bushry� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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� FOR DEDUCTION FROM ASSESSED VALUATION
, • State frortn E3709 (R71 / 609)
�` Pr�aiGed by Department o( Lowl Govemment Finance
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�srnucnoNS: F� fl� �
To 6e fded in person w by mail with Ihe CountyAUdROr orCounry Recorder o! the county where the property is�d� '�
Fi6rg Dates: i) Real Property: Must file during the year for which the deduclion is soughL � Counry Auditw
2) Mobde / Manufactu�ed Homes rat assessed as Real Property: Must fi!e dunng the hvelve (12j�nonths
6efore Maich 37 of each year the deducfion is sougAt �- � J_ ❑ Counry Remrder
See 2verse side /or addrfional instrucUons and quali�cafions.
nppfxaAt(ownermcontrarJbuyz�-seereunftiawmreverses�e) ' �
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rcm.�.nsi�nain��c�
If �ame on 2mN
Key iwmber / legal dnsaiption RecoN number Pa9e numbv
- ol - oo - vo�, �a 5- oa/ Do8 a�
d A1ortqa ge / ContrarY iMebtedn�s unpaid as U Mortgaqe I Con�act'vMe6te0nes5 �mpaid as d Is the aPP�^t the sde
March 1, airte�rt Y� tlate W aPP���n kgal a eW ila6le ownM
I� QQ Q ❑ Yes ❑ No
ot inteRSt? It awned wi� snmeore other Ihan spouu. irN'rate with wMm
i that of aPP�^�• mtlicate bebw. I5 Me OroDenY in VuesUOn: MnuaDy Assessed
❑ Real ProPeRY ❑ �^!!�Y � . " '
Name of mortpagee « crntract se�ler M y�/}� � .
� / ' l I •
Addtess of rtiort9a9ce or mntraG sWer (numbar end sbee; rily, state. ard ZIP �
Name of assignee or oNer owner w halder of mort9a9e
ACCress assgnce (number aM streeG rd}; stEta, end ZIP cotle)
Does ePDlipnl own pmpnrty in any olher If yes. what � I
munryinlMiana? ❑ No
n „es
mon aFyo+ed'u� ihe amoum at
�_ � �_ zo
�- � I • / �' "[/ r
I/ We certify under the penalty of perj that the
owner I contract buyer of the aforeme � ed pro
, 7 9S A �-
YMat Ta�d(g DisViU7 Nas Ihis �
fw amer
nd toregoing infortnalion is tn
date applicatlon is filed.
ary, state, arM LP code)
sted m P�Y
Yes ❑ No
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Dra��'er \O.•• �
Card NO. ....��'�...1......
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I vate (nmth. daY• Yae�
Person auNO�d Dy tluty ezecuteE Pvaer of Aucmey or by IC 61.1-72-0.7 I Date (mon�+. dfi:
Pddress o( authaaed person (number aM streel, ury, sfate, aM ZIP cotle) .
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