HomeMy WebLinkAboutMortgage_Toth (2)'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
:�_ _ FOR DEDUCTION FROM ASSESSED VALUATION
Smte Fortn d3709 (R71 / 6-09)
S,.,. Pr�aibed by Departmem or Laal Govemment Flrence
INSTRUCTIONS:
To 6e filed in person w by mail wifh the CounryAWitw or Counry Recader o/ the counry where the pio is loca .
FTtng Dates: 1) Real Property: Must file durirg fhe year for whirh Ihe derluclion is soughL
2) Mo6�7e / Manufauured Homes not essessed as Real Property Must file during the fweNe (12J m��i� �
be%re Maich 31 o/each year Ne deduction is saght.
See reverse side fo� adtlitione! insWCGons and quel�cafions.
l�oM�rarl (owner u conlraC b�n+er - see rasLirbw�s m mversa sidel . .., /� ' F' n
Tabrg Oi.trict
� ��
March i, a+ma year
tt m. what Is Ns ! hei
�} IINIIE IXI f2mf0 6�
-,{�U CounryAuditor
4� Counry Recorder
� Key mdnCer / legal desaiption Remrtl numbc Pag m�mGu
a6 -J�-oa_ 300-00�.38�-0� o�o �D$.3
a ol Mor�qa9e / Cantraa 4dehted�ress unpaid az d Mongage I ContraU iiWebtedness unpaiE as d Is ihe applirant Ne sok
Mert�h 1. artent C3tB ot aVP�� lega� d eWimde Owne(1
� � �%� (� j� ❑ Yes ❑ No
ofinte�est7
Name oi mortgagee or mntract se9er
Address of mortrya9ce or cantraG seUer
Name ot asignee w othel oxner w tmlder W mortgage
r (numOeraM Speet,/ ray, slate,
O J �
p�operry in any oNes
���,�����of
cdy, state, eM LP code)
�� c� %� L
s,whatmunt}? WM
COUNTY AUI
20 _ � 20 _ � 20 _ � 20
wmeone other than spouse.
Is the ProPert1' in Question: MnuaM Assesse0
❑ Real Property ❑ Mnually Pssessed
MoWle Florr�e (IC 61.
Dra�ver NO.. o�Of d.......
Card NO. ..!„��3........
5(3 �„� .
� I S$,I00. pO/
20 _ ZO _ I
� O�Y
20
�/ ' � _/� /J ' / I cw�y I oata (nw+w, aar, r�n
i I We certify u er the penalty of perj that Ne aDOVe and foregoing information is W e and rvrrett aM that the appli�ant is a resident ot Iridiana and
owner I mntrad buyer of the aforementionad property on date application is filed.
� ,,.drawre (ownefs 0 frertre)✓ Date (nm+A, daY. Y��
FWI rrsitlent atldress d appGmnt (numDer and shee; riry, slate, antl LP cotle) I
� f3 a 6 a �/ �% �� �� 2✓L.S J L I
Person autlp�¢ed Dy tlWy ezew�ed Power af AttorneY a M IC 61.1-12�.7
person (num6er arM Sbee; tity, sfala, aM Z!P Code)
� /ll�Li
Date (monN. EaY• Y8�