HomeMy WebLinkAboutMortgage_Phillips"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C ear
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fam 03709 (R71 / 6-09)
�• f Presaibee by �eP��M of LoCal Govemmenl FflBnce
File Mark
wsrRUCnoNS: ,J
To 6e filed in person or by mail with Ihe CountyAUditor or Counry Remrder o( the county wheie the pmperty is located.
Filitg Dates: 7) Real Pmperty: Must file durrng the year (or which the deduction is sought. f�o ty Auditor
2) Mo6ile / Manufactured Homes not assessed as Real Property: Must file danng the tweNe (12) months ,(5
6e(ore March 31 0! eacA year the deduction is sought. �� Remrder
See reversa side fnradditional instrucffons arM quali�cafions. GIBSO
dreal asm
Ma�rh t. year
Ii ro. whai is h'a / her e�2 share Of intere5t?
If rwrre m 2crortl is E'iRerent Nan Nat of aPpl
� Name of rt�ee a contract se4er
r r �Qi .—�� a i, i s� �.s �J
'
seAer (number aM saee6,tdy. sfate. aM ZIP code)
Name of asUgnee or othu owner or hoHer M mortgage
Mdress of assignee (number eM.VreeL bry, s7Ete, arM Z/P catle)
Ooes appliont am property in any oNer If yes. what �
counry m InEiana7 ❑ Y2s
❑ No
Deducfion approved in ihe amount oF.
20 20 2tl
Sg�anae d Camb AW itor
a�metl �tith
� Reco�d number Page num6er
-�?/ ao�� aa
Contraa uWe6tedness unPaid as of Ls Ihe eGP�t the sale
�'S�°" le9al a eWitade wmeR
iS rY"N) n Yes ❑ No
IW�atTadng OistnG7
COUNTYAUDROR
20 20
Caunry
I I We certify under Ne penalry of perjury that Ne above arW foregoing
owner I contract buyer of Ne aforemerrtioned propefty on date applicat
i fs/idn2rzR) %i / . _ . i. / �
re WoPertY in 9uestion: MmiaM Ascssed
Rea� amaenr � ��N �
MoMle Hort�e (IC 6
Has Nis tletlurlion Oeen requested m ptoperiy
far wrtent yeaR ❑ Y� �
� �
Oate (monM. daY. Y��
�rtnation is We and wrtect and that the appiiran[ is a resident of IMiana arM
is filed.
J
trata (rtmth, daY• Y��
�- a� -ia
Person autho�¢eE Ey Auty esecuted Power o( AROmey or by IC G1.1-12-0.7 I Date (rtpnfh. Eay. yea�
lWd2ss of authwssed person (number antl sbeef, ciry, stare, anC ZIP code) .