HomeMy WebLinkAboutMortgage_Henderson (3).«� °'�. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 7 � Year
� FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form A3709 (R8/ 2-07)
S � Presrnbed by Departmenl of Local Govemment Finance
i e Ma
INSTRUC770NS:
To 6e filed in person or by mad wdh the CountyAuditor of the couMy where fhe property is located. `-y�7 ��
Fd'urg Dates: 1 f Real Property: Dunng the 12 monlhs before June 71 W the year the deduction is to be eAecfive. 0��
2J Mobile Hames assessed under 1C 67.1-7: Aelween January 15 and March 2 o/the year the deduc6orlysfo�� eL9 ��Y AUDITOR
See reverse side fw addifional insbuctions and qualifications. �' «5
Applirant ( m or mN+a �Ye�' 29ncfi n reverse �
Taqng Di ' Key mpnber / 1 � �
U O ( ei -
Ass�se vdue ot real propaty as d MaN� 1, artenl y�r MMg
airter
�(ItO. Wh2I15 �IIS I hCf ¢%2d ShZfE Oi 11f(Q25I7
It�e on record is diRerent Ihan ihal of applicanl, indipte belaw:
Name af rtar�qagee orconUact seller � �j �, �f
Address of moAgagee a mnirad seller (num0er ana st
Nartre of assig�e w alher awner or holder of mortgage
Address ot ass9nee (rnuMer arM s4ee4 cily, sfate. ana
pces applicanl own poperty in anY other
courLLy in Indiana?
❑Yes ❑ No
Deduction apprwetl in lhe amount ot
�� �_
�
Siareture of CaunW AudMr
sfafe. and ZIP code)
what cwnry7
couNrr
a�%-O� /
ness unpaid as of March 1,
xd nurJr ber Page rntmbel
oos �8ga--
il lhe sde legal w eqw�aEle avne(1
❑Yes ❑ No
mmeone dher Ihan spouse, indica�e wiih whom.
Is Ihe property in question:
❑ R�I Property ❑ Mobile Home
What Ta�dng DisUicl7
Dra���er ��• ��5........
'�sq..a........
zo zo_ CardN� •• •• o�
� �t a, 5�a . —
c oa�e (mc
i requested on property
❑Yes ❑No
2� _
1/ We certify under Ihe penalry of perjury that the above and (oregoing intom�ation is trve and corteU and that the applicanfs was / were a residenl of
Indiana and yprner of the aforementioned property on March 7, 20
ideni adCress of applicant (number and�tre e1 cdy. sfate. aM ZIP code)
p, S 5 9�v ... pw7.lS✓�IIC � M' Y7(o6S
Person aWwr¢ed by Ouy euewted Power of Attamey or by IC G7.1-12-.07
persm (number aM sheef, cCy. slate, arrd
Dale (month, day, yea�
Oate (montA, day, yea�