HomeMy WebLinkAboutMortgage_Nieten"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 03709 (R11 / 6-09)
� P�esai6e0 Ey Departmerd o1 Lnml GovemmerLL Flrence
I
WSTRUCTIONS:
To 6e filed in person or by mail wiN the CountyAuditor or Counry Recorder o� the counry where the property is located.
Fi6ng Dates: 7) Real Properry: Must file dunrg fhe yearlor whirh tha detluclion is so�ght M
2) Mobde /Manufactured Homes rrot assessed as Real PropeAy Must h7e dun�g Me fweNe (72) months
before March 31 0( each year the deduction is sought. C
See reverse side /or additional instructions arM qual�cafions.
�,. npq'cay� (ownerorconhact 6uye�-/pg �esficeans m�wrse sidel G I BSO�
� I legal desaiPUOn
Jn-36-/o/-ooY
Nortgaga / Contract irdehtedness unpaid as of
Nertl� t, artmnl year
tt �wrie m remrd
Name of rtiortga9ce b mntracl seUer
AAtlress d rtprtgagee ar mntrad seder (numtlr� and streef, Uy, sbte, aM ZIP code)
Nama of assynee w other ovmer or holder af mmgage
A ress ot assgnee (namber and stree4 �: stale. and LP code)
s� � _.�_ a a.yy,
Does apptiranl a�n property in any oNer If yes. what muntyl
counry in Ind'ana?
❑ Yes ❑ No
�—�.- o �
Mortgage / ConVart irWe.
date W aPPGCation
�. ry Recorder
,. N
number Page numMi
o�l 7S
fs of Is ihe eppdtlnt tlte 5de
legal ar epuitade axneR
❑ Yes ❑ No
U owned wkh someone other Man spouse. irid'xate with ��Rrom
15 Me ProGenY in Vueztion: Mm�aAY Assessed
❑ Re� am�ty ❑ amuany w�e
y Alnhila F4mn (I(: A
Dra���er i\�O...s:��.l.........
L Card i1`O. ....�.G� 5
........
9 D�� ... I��I G V✓ .�/•J
COUNTY AUDITOR
D¢Euction app�wed'ci the artauM at
20 _ 20 20 _ 20 _ 20 _ 20 _ 20 _
Synawre W Camb Aud'aor Couny Date (rmvn. daY. Y��
C • T•
I I We certify under the penaly of rjury that Ne ve arW foregoing intortnaGon is We and mrtect arW that the applirant is a resident ot IMiana and
owner I contract buyer of the aforementioned p rty on date appliration is filed.
Sip�Wrt r fs fW re Date (rtmfi, daY• Y��)
� i [fPtiti
�u0 revderrt f appGCant (number aM sLee( �}: state, anA LP )
�sy6 � a s Du��vs�, �� �
Pason autMraeE Gy dury esecutetl Power of Attartiey rn by IC 61.1-12-0.7 Date (rrmth. tlay, yxa�
Addr� W ainharaed person (numDeraM sneef, Wy, state, antl LP cade) ,