HomeMy WebLinkAboutMortgage_Poskin^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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FOR DEDUCTION FROM ASSESSED VALU�� ��
Slate Fortn C3709 (R11 / 6-09)
�' � P�esoibed by DepartmeM ol Loral GovemmeM Fnance
� File Mark
�srRUCnorvs: f1C(� p ��11
To be filed in Y ty h coJd(y W ecpa�perty � F� �� ��:
person or b mai/ with the Coun Audiror or Coun RewNer o/ the hdle th is bcated.
Filirg Dates: 1) Real Pmperty: Must file during Ne yrea� /or which fhe deduclion is soughL �Counry AudiWr
2J Mo6de / ManufacNred Homes not assessed as Real Pmperly MusY.IDe°durfigl(�7�g�ve (72) monfhs
before MarCh 37 0( each year the deduction is sought. �`\\ ❑ Counry Recorder
� V
Seereversesideforadditm�Ljnswctionsandqualificafions. , GIBSnN[:niiurveiinirno
�
If no.
m
Keyfwm0a/kgal
w
Nat W aPP�t hduate Eebvr
Name ot nwtgagce or mntrarl seller
Address of mort9a9ce w mntraa se9er (�
Name of assignee w ocher awner or twld�
Ad�ress of asvgnee (number aM street
Does applicanl own property in any ol�er
munry in Ind'ana?
❑ Yes
D�uc6on approv�-0 in Ne amount of:
20
Sig�aane W CnmtyAUertnr
`�� I D :l�P'� �D I'-0w. i L.'J ��. f Remrtl numDer Pe9� S 5�
D a-
aa 4de01edness unpaitl as W Mongage / Cmtraa 6de6tedness unpaid as of h Ne eppGOnt the sde
ypm Cate of aPPfration legal or eWita6le owiceR
❑ Yes ❑ No
If owned vnN someone other ihan spouse. indrate with whom
mortgage
slate. and ZIP oo0e)
If yes, vMat counry?
No
20 _ � 20
2�
Wha� Taong
Is Cre ProPenY in Questian: MnuaOy AsscsuA
❑ Reai RoGertY ❑ Mn�aI1.1! As�ed
�Y
❑ No
aQ!.1.......... -
D,��„-��_ �o...... _
, Card\�c"'��...........• _
_ '_ :.1�5���.yS .,
I/ We cerOfy under the penalry of perjury that the above ard foregang information is We and cwrect arW that tlie applit2nt is a resident of Irdiara aM
oxner / mntract buyer of the afo2mentioned property on date applicatlon is filed.
�naave lawie/s fid rbrtre) � i. � Date (rrmN. daY. Yee�
addrass of appGant (number antl sbeef. tlry, sfate, antl
7 /
aWaraetl by d�Ay execu�ed Power of AttvrteY w
person (number aiE sbuet dly. state. antl ZIP coAe)
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