HomeMy WebLinkAboutMortgage_Keller^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
,__„ � FOR DEDUCTION FROM ASSESSED VALUATION
. . ' State Form d3709 (R77 / 6-09)
�' ,,,. Presaibed Cy Departmem ol Larsl GovemrtreM Frerce
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�srRUCnoNS:
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To be filed in person w 6y mail wiM �he County Auditw o� Counry Remrder of the oo�nry where the pmperty is located.
F�7irg Dates: 7i Real PropeRy: Must file duri�g the year (o� which fhe deduction is sought Coun Audimr
2) Mo6�7e / Manufactured Homes not assessed as Real Property Must file dunng the M1velve (72) months .�. �
6efora March 37 of each year the deduction is sought. u Recorder
See 2verse side for additional insfruUions and quali�cafions. r_ i o e nu rn� � nirv e� i n�Tno
llegaldesaiptlon
' �e- 3io - `�h�-C
.brtgage / Contraa intlebtedness unpaid as
Aamh 1. wrren� year .r� ./'�
��Z n('lJ
If ro, what is ha I Mr eraU share ot interas[?
If name m tycort! is Cifte�ent Nan �hat of applitan4 ulditate 6elo�r.
NameI oi rtqrtryagce or conV3tt Se4er
Mtlrets U mUgagee a conbaa seDer (number and sfiea4 �: s+ate, antl:
Name of assignee w o�er owner w halder ot mortgage
Addmss of asagnee (number aM stree4 �+y, slate, and ZIP cotle)
Does applimm wm property in any ollier _ If yes, what munry?
Deduction approveC in the amount of:
20 � 20 � 20 � 20
a
What Tari�y Distrii['t
20
Record number Page num6er
�al� �
unpai0 as W Is Vie appliont Ne u
� � u No
spouse. irMinte with wtmn
�K DroOertY in puestion: MnuBOy Asse55ed
eal PruPenY ❑ �Y �
Mohde Fbrt�e OC 61.1-]
K�� aR�;- � - _
i/_��8 'DE�q'v'U'¢ ,C..
20 � 20
Sig�aW2 N CounN Auditor I Counry I Date (monfh. AaY. Yee/)
I/ We certify urWer ihe penalty of perjury ihat the above and foregoing infortnatlon is true and correct a� that Me applfran[ is a resident o( IMiana antl
owner / conVact buyer of ihe afwemenlionedproperty on date applicalion is fiied.
FLtl refWe'Ifaddress U applicant (nulFAer ari0 sbeet, rity, sfate, arM ZIP code)
'P 4of� 7 S. 700 t� p,,,�„s,,;
Person autlrorizetl by Guy ezecutetl Pw.er NAUOmey a Dy IC E1.1-12-0.7
Pddress of authoraeC pnson (number aIM sUael. tlfy. slate. an0 ZIP catle)
Qace (monN. OaY. Y��
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