HomeMy WebLinkAboutMortgage_McClellan (6)^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__, � FOR DEDUCTION FROM ASSESSED VALUATION
. . ' • State Fo(m C3709 (R71 / 6-09)
S ! p��bed by DeP��rd of Wal Govemmenl Firence
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�WSTRUCTIONS: A F!r��M�
To 6e filed in person w by mail wiM the CountyAUditw or Counry Recorder o/ tAe counry where the pioperty is located. „P • �7 Lu � G
Filirg Dates: 7) Real Pmperty Must file during the year for which Ne deducUon is sought Counry Auditnr I,
2) Mo6ile / Manu/actured Homes iat assessed as Real Pmperty: Must fiie dunng [he twelve (12) monthsC .�. unry Recorder
6efae Ma�ch 31 of each year Ihe Ceduction is sotght.
See reverse side (a addrWnal instrticGOns arnl qualifications.
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P�Y
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MaG� i, nrtrent Y� I marrn i, W�ry�` yee
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I( ro. what is ha / hu e�d share OI interest?
If �ume m reoDtd 6 dfiefari fhan Nat ol aDp�'ani, uiOiCate Cebw.
Name ot mort9a9ee or mntraU seller
Addrea W rtnrt9a9� w wntraa se0er (number and streel �Y. state.
Name o� assignee or ottrer ownet w twlder of mortgage
pry, sfale. aM Z/P code)
w.n ypp�ty in any olher
�� ❑ Yes
�� �� m � a���
unpaid az of MMgage I ConVad iridehted�ss unpaid as d Is the appihanf tha sole
datc of aPP�� kgal ar equitable awne(7
❑ Yw ❑ No
I( an+red with someane othu than spouu. irdimta Wlh wt�n
Is me wovem io auestion: rwwaM wsscssed
❑ Rea� RopeM ❑ Mnualh'ASes�
Moh�e I-lart�e (IC 61.1-i
mc c ��1�a�, �oN�n �-
�CDti UtXcy K
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�dudirn Deen requested on propMy
�� ❑ Yes ❑ I
20 20 20 20 _ 20 _
�iaWre d Counb PLditor Counry Date (rtmih. daY, Y��
I/ We certi(y under the penalry oi perjury Nat Ihe above and foregoing intortnation is We and correU aM that the applicanl is a resident of IMiare aM
owner I contrad buyer of the aforementioned properry on date appiication is fileG.
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�y$i¢�iCC6[adCress W app6�nt (nun(Oer anG stleet.'ary, state, and LP m�
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Peisw� aWqrrsed bY tl�'/ ��� �°^'�� °F�OfTeY °f q' IC 6t.1-12-0.7
P4dre55 of aNhor'ved persm (number aiM stree4 �'. �re, antl ZIP code)
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