HomeMy WebLinkAboutMortgage_Ducann STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS To p vear
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
• State Farm <3709 (R77 / 6-09)
S � pi¢svip¢tl �y DepartmeN af Lad Govemment Fuiance
"" AP FileMark
iNSrnucnoNS: F� ��
To be filed in person a by mail wiM fhe CounryAutlitor or Counry Recorder of the counry wAera the properry is located-
Fitirg Da[es: 1) Real Properry: Must fife dun� the }rear for which Ihe deduction is soughL � unty Auditw
2) A.fobde / Manufectured Homes rwt assessed as Real Property Mus! file durirg the hveNe (12J maiMs
6efore March 37 of each year the deduction is swyht. nry Recorder
See reverse side !or edtlilional inshuctions and qualifications. Q IBSON
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rc�y n,m�i �eya aesa;c�a,
!c -17-a�-/o0 -Oo� 3Y5_
d �ge / Cantraa irdnbtedness unpaid a d Morigage / Co
Ma 1, ar2nt yeer �� Eace of appfrca
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tt m, whal ls his / tret exM slure af interest?
tt nane m 2cptl "a dAferent
Nama
u�.�.r- W
saneone
A� �'d �.��.�t/�a�
se�er (numDer end sbael, rdy, ste�. eM ZIP mde)
w holEer of mortgaga
��u� ar�a s�c �: sm�e.
Ooes ePpli�nt own pioputy in any oNer
couNy m IM'vna? f'"l .,_ _
Detluction approved In Me amount ot
20 20
Sig�wre d Co�,N awnw
btedn�s unpaid az of I Is Ne appEanl Me sde
legal w equitade amM
❑ Yes ❑ No
spouse. iMkate wiW Mwm
15 tlie pope�ty in GuesGan: Mnua�y Assessed
� Real Plopefty ❑ Mnually ASSe55ed
�Lr�c:a►�, m��a A6 �. �
o� QE (�S� D
COUNTYAUDROR
20 20 20
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I I We certiy undes Ne pen�liy ot perjury that N bove and toregoing infortnation is we and cortect arM Mat the applit�ant is a resident of IrMiana and
owner I contrad buyer of ihe aforementioned perty on date appl'ication is filed.
inanue owner's 9qne Date (rtmW. daY. YgeA
� 4! � �v►f--
7 revtlent appfimnt (numDer and sLee4 �; �re, and LP code)
�Dy89 w 7.5� S D �,�s ��/� � y76G5
rsan autho�ee ny MAy executed Pow�er ofAnomey w Oy IC 6t.7-�2�0.7 Date (rnorvA. a�: yee�
Mtlress of autlmved D� (numbe� aM straeL u�: state.