HomeMy WebLinkAboutMortgage_Meeks (3)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Towns ' Y
_ : FOR DEDUCTION FROM ASSESSED VALUATION I
• Stata Fam G3709 (Ri t/ 6�09)
S I Presaibed by DepartrtieN ot Lcwl Govemmenl Fi�nce
�µ File Mark
�STRUCTIONS: �
be filed in rson or b mail wifh the Coun Auditor or Coun Recorder of the coun whe2 the io F� �
PQ Y �Y 0' N P PertY is located.
fd"mg Dates: f� Real PropeAy: Must tle during Ne year Po� which the deduction is mught. O_ .po�y����tlr�
2) Mobile / Manufactured Homes rwt assessed as Real Property: Must file dunng the hveHe (12) months ❑ \\ �\
6e7ore Ma2h 31 0( each year the deduction is soughL Counry Re2order )
v DITO
See reve� side !o� additional insauclions anc�qualficatrons.
npprra �( or cono-aa buy�er/aee 2 � a^ rpv�rse siie) n� /
A'ss�5� rahm d real property a of
Maza/1, qmeni yG9r
If rw, what a his / tcer exa1Y share of u
If `wne on recottl ¢ S�Rerent ihan iha
Name or rtwrcqayee «conaau sel�er
Ifr I legal �Eaaipy'�^ �
���o- OO.p00,Q��-D�/
Mortgage / Contraa iMMtedness unpaid as W MMgage / ContraU uW�
MamJ� t. o,rtent yenr tla[e of applifatim/ /
Address W matqagce a mntract seJler (numbe�
Name of assignea n other rnmer or hdder of morrc
MCress of asagnea (number and snee; ary. state.
vm0irate hebw.
state.
cade)
property in any oUer I If yes. what munry?
❑ Yes ❑ No
as
someorie dhef iHa�n spouse, iMimte with wMm
w equnade ame(�
❑ Yes ❑ No
Is Ihe property in Question: MnuaDy AssesseE
�'R�i a�overtr O !�!!aM a�a
� o��-�—/�2 a.// C�
wna� rapoy o�v�a? Nas N� aea� o�� rea�es�d o�, a�oa�r
for current yeaR ❑ Yes
❑ No
1 .--___ ,./...�,urv.eiuvrno. . _ _
Deduclion approveE in tlre amoum oE �^ i I.�
IV J ' G -
zo_ zo_ zo_ llrawcr \`0..��0.........
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.................
� R' �� �9�,oc�O �°
I I We certify under Ne penalry ot perjury Mat the above �'1 S.(hcclto
owner / wntrad buyer of ihe aforementioned property on date applicatbn is filed.
� Signaw%(a s a�rre)
Full resid nt ress ot applkant (numDar antl sbeet, stafe, aM Z/P aorl
� �.50 5 (�'v15U�
Person autimfaeE 7y dWy ezeaitetl Power d AttomeY � b'/ IC G7.1-12-0 7
Address of authometl person (number aM street, ary, state. aM LP aotle)
�o m
�� c,�,a+w,, e�r, r��
�plinnt is a resident of IMiana and
oa� trr�«,m. eay. reen