HomeMy WebLinkAboutMortgage_Hale^�� STATEMENT OF MORTGAGE OR CONTRACT INDE
__ FOR DEDUCTION FROM ASSESSED VALUATION
• Sfata Fortn G3709 (R71 / 6-09)
� PresaiEeE M�rtmeM o1 Lo�l GovemmeM Fuiance
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WS7RUCT10NS: C
To 6e fJed in person or by mati with the CountyAWitw or Counry Remrder of the counry where the pioperty is located.
Fr6rg Dates: 7) Real Property: Must file dunng fhe yearlw which fhe deduUion is sought. q�d��
2) Mobde / ManufaUUmd Homes not assessed as Real Property Must fi7e during the fweNe (72) m�i�SON OUp�y ��de
befwe March 37 0( each year the dedudion is sought. LJ
See 2verse side /or additbnal inshucllons and qualificafions.
Aaa�a��(yG�erorconuanbflver-sfemrsvir�nsm;everseside) �. �%
narmt year
fs his I Mr exact shara ol interesl?
�-aoo a�o�33-oa/ i 3.�
I ConbaU IMebtetlness unpaW as of Mortgage / ContrarY inde6tedness unpaid as d Is ihe epplirant Me sole
vrtem year Eate of application kgal or epuiqde o�meR
3 R�Y') ❑ Y� ❑ No
If rume m record is ddferent tlun tlul of aPpOCant, cMkate below
������,��u��3
AGtlress d rtprtgagee or mntrad se0er (num6er end stree4 ciN. s7ate, aM LP code)
a oNU wmer w halder M martqage
PdC�css of assgnee (numDer eM atree4 my. sbfe. and LP cotle)
ooes evdipm o«„ cmaertr � a,y ang
munty in Indiana? 1-1 .."_
Pi�]
Sigfa4rte
20
oE
v�hat
�_
N awned with someone other �han spouse, indicate witt� wMm
Is Ne property in question: Mm�eVy AsSesud
❑ Real Property ❑ Armually Assessed
Dra���er \`0..��.4........
Wtut Ta
Card No. ....535.(�....... o No
COUNTY AUDRO � a2 $�, � _
.A
20 20
County
�'i�7
oa�e (�w,rn,
20
I I We certfy unCer the penatty ot perjury that Ne above a�W foregoing intortnation is true and correU arM that Ne applirant is a resident of IrWiana and
amer I contraG buyer of the aforementioned property on date application is filed.
ow�ers fu0 nsmeN /1 / Date (month. tlaY. Y��)
sbeet a1y, slate. and ZIP coda)
duly r�ecuted Powef ol AttomeY ��' IC F7.7-12-0.7
Pddress of authomed persm
(O �
n�� (monfi, daY.l'e8�)