HomeMy WebLinkAboutMortgage_Mossberger"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ = FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn C3709 (R11 / 609)
�' � Prnsaibed by DepartmeM of Lod Go+emrnent Fuwce
w.
wsrRUCnoNS:
To be filed in person w by mail with the CountyAuditor or Counry Recorder of the counry where the pmperty is located.
F�Ting Dates: 7J Real Properry: Must file during the }rearlor which the deductbn is sought.
2) Mobde /ManufaUuied Homes rrot assessed as Real Prtipeerty Must file dunng the twelve (12J months �
before Maich 37 of each year the deduclion is soughf.
See reverse side (or addilional instructbns arM qualifr.ations.
C
Applrant( ormn7raGbuyer-see versesitle)
�C,pypjyAuditnr
/ 1111
Cauhty Remrder
l 1//a IOM_.[4_ l�) t/ti.. D.l 0 J�a� %� 9 1 1/4�11YSPi 01P.L_ ��BSON COUNTY
�ssea �awe �rre� a�v es m
a�M 1. amM Year
M. W�18� 6 �IIS ��IC! BYdLI 5�I2f8 Oi N}CfB5l7
If �wne m 2tutl is SMe1mt fhan thal of app6ran� u�tluate Celow.
Name W rtnrtgagee or conirap seller
nedRSS ot rro� « �,o-aa
oNer ovmer rn naF
AOtlress of assignea (number aM st p� '--
Dr. er �\
ooes aPPtiram wm woP�' in any 7l1' �O. ..�-�/O I O.. ...
w �•�l
munryinlndiana? . ..... `"'��
❑ Ye: C81�(I 1���. , �
DeOumon aPW� in ttre amoun �� � �+� �� a� • • • • .
«e
zo 20 � zu i _ _.
sigreane d cauib welmr
g Distri�Y?
zo
unDaid as d Is Na eP�� the sole
lega� w epueaMe awwn
n Yes ❑ No
Is tl�e property in puesUOn: MnuaDy Assessed
❑ Real ProPeKY ❑ �^��Y�
Modle Hort�e (IC E1.
Has this de0uction been reVuesteE on pmperty
tw wrtent yeaR
❑ Yes ❑ I
s���m
I I We certify under fhe penalty of perjury Nat Ne above aM foregoing infortnaUon is We and cortect arW that the apD���nt is a residenl of Indiana aM
owner I wn4ad buyer ot fhe ataementioned property on date applira0on is filed.
7��e�4N'+le/slullreme) /nn Date(monfi.daY.Y��)
e�.� .�
Person auuwraetl oy
stree4 �1; s+ate. aM LP code)
person (numOeraM sOce( ctty. stete, an0 ZIP cada)
Date (rt+nvh. tlaY. Y��
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