HomeMy WebLinkAboutMortgage_Martin (31)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7 shi' v r
_,_ � FOR DEDUCTION FROM ASSESSED VALUATION �
• State Fortn A3709 (R11 / 6-09)
�'' ,�,� 1 Presoibetl by Department a! Loml Gwemmem Frence
INS7RUCT10NS:
To be fi(ed in person w by mail with Ihe CountyAuditw o� Counry Recorder of the county where the pmperty is located. �
Fil"mg Da[es: 1) Real PmpeRy: Must file during Me }rear for which the deducGon is soughL � Cp G i�p�
2) Mo6de / ManuFaUUred Homes rrot assessed as Real Property: Must file dunng the twelve (72J montAS ��v
6efore March 31 of each year the deduction is sougAG G I B N� U(�����
See reverse side 7or addifmnal instrucGons arM qualificafions.
qpp�n� (m�5qm^trert Dvyer-"_ resMrJVUOru�p re side) -Ci" / , / / • / QJ�O"�
� � 'u`i[�ea�v C� �J
T' ' triti KeY rwmber / 1e9� `�smp � �� — O Rem�d numbrl Pa �wm //
AssesseC vaLe d real P�P�Y a d !Aart�age / Contraa inde6tetl�ss unPaiA as W Mortgage / Convaa udebtedness unP� az of Is Ne eP�� Ne sole
Ma�d� 7, qpreN yrar March t, a�rtem yrar date of appGcation kgal or epuitade ovme(.�
❑ Yes ❑ No
Ii ro. wfiat Is his / her eraG share o/ interest? If awnetl wiN snmeone oUrer than spouse, iMkate uiM Mwm
If name on reco�tl'a NRuent than ihat ol appfvant, uMipte Oebw: r�} p,K. „P�p¢rty in QuesUOn: MrwaDy PssesseE
. / � ' ��� ❑ Moble Fbrt�e�(ISC�61.1-7)
Address of mort9a9ee w contrad
Name of assignee or other awner
Addmss o( assi9nee (number arx
any other
Yes
srare, and
ale, and ZIP tode)
���.������
No
�
— _ �(��� c�S m ,—
SI-1�'y U' - "
� �a-��iG H
LA Yes LJ No
De�umon apP�'� �^ �e amount of:
20 20 _ 20 _ 20 _ 20 _ 20 _ 20 _
Sig�ature ot Co�mb Auditw Counry Dale (rtronth. daY Yea�
I/ We certify under the penalry of perjury that Ne above and (oregoing infortnalion is We and cortect and Nat the applicant is a resident of Indiara arxl
owner I wntraG buyer of the aforemenlioned property on date application is filed.
� �deOnt a01ci�7(a�nT ! 3 ' and �6ei.LiQ.i'� StV "e1P � /" � � � � �
Person authomed by tluty �ecuted Power af �Attomey or Oy IC 67.7-72�.7
AEEress of auNOrrzed person (numberand 5Lee1 �: sb(e, anU ZIP ootle) .
Date