HomeMy WebLinkAboutMortgage_Slunder"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
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= FOR DEDUCTION FROM ASSESSED VALUATION
• State Portn C3709 (R71 / 6-09)
�� f Presaibatl by �e0artmenl 01 Local Govemment Fl�nce
�NSTRUCTIONS: ` ��y��
To be filed in person w by mail with the CounryAUd�ROr or Counry Recorder o! the county where the pmpeRy is locatefl � T Fi L U 1�
Filirg Dates: iJ Real PmpeRy: Must file dunng the yea� for which the deduction is soughL County Auditor
2) MobBe / Manulactuled Homes not assessed as Real Prtipeerty Must file dunng Ne twelve (72) mont(�S, 7,
6e/ora March 37 of each year the ded�ction is sought County Recordu
See reverse side for additional inshuuions and quall(icatbns. O C N
AppGrant(o�vceinmWdflbuyer-sey�25tricbmsq�leversesde)` t . ',,
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rnmeer UeSa� eesciption
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A/oriqage / Contraa'udebted�ress unVaid as W Mort9� / Contra�
Mart�h 1, Surtent year dare of appfication
If rarte m iewtd is CiRerent Ihan Na� W appfirant, uMirate bebw.
Name of mortgagee or mnvad seller . n . _
// V%C . � IiTI-�c/�/ . ' _ %
Atltlress of mwtgagee w contract uUer (number and stree; dry, sfete. aM LP code) --.
Name M assignee w aNg ovmer or holder ot mortgage _ � �`\ . .•.
_ a.......::...� �
� � �
Adaress of assignce (number aM svee4 �}', sfafe �O , • • • •
Di'����� . .
Does applimnt own propelty in any oNer ��� •
munryinlnd'ana? ❑ Yes ❑ No �O ' � �
��,�� ���q�y��-��
DetlucOon app�wtW m Ihe amount
20 _ � 20
I/ We certify under the penalry �j'perjury that
owner / mntract buyer af the afaementioned
�naWre (owner3 MI name)
1
en a tlres of appliranl (num6er antl sLeet, �
Pason
, t, 1Q i
Retotd w bc Page �wmbr!
6tedness �mPaid a d h Ihe aVP�i Ure sde
legal w epuita6le owneR
❑ Yes ❑ No
spouse. iMira[e witti wlam
Is Me pmperry in Question: Mnua�y PssesuV
❑ R� �aeM O ��r �
Mobile Hmie (IC 61.1-�
Has ih"s Cedumori Eeen reCUested m propelty
�, a�� � r, r,
20 � 20 � 20 � 20 � 20
Pdtlress d aW�o�'ved person (num0erand snee4 �Y. sbfe.
e aM (oregoing infortnalion is true and cortect and that the applipnt is a resident of IrWiana aM
on date appliralion is filed.
�Y• YE�)