HomeMy WebLinkAboutMortgage_Allen"^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ � FOR DEDUCTION FROM ASSESSED VALUATION
Sfata Fortn d3709 (R71 / 6-09)
,' ,,,, � Presaibetl M OeParlmeM W Locai GovemmeM Firwce
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INSTRUCTIONS: R
To 6e filed in person or by mail wifh Ure CountyAUditor or Counry Recorder of the cnunry where the property is located. H��''�''
Filing Dates: 1J Real Properly Must file dunrg the }rear /or which the deduction is sought. � Counry Auditor
2) Mo6Be / Manufactuied Homes rat assessed as Real Property Must h7e during tiie lweAre (12J months
before March 37 0! each year Ne deduction is sought. �e1
See reverse side 7or aQd'tional insVUCtions and 4�lrfications .-----....t.. .� �nitna
Assessed value d real P�P�Y %s d
Ma�Gi 1. a+relrt year
WhB� �S hISI hG 8ll2Ct 511818 0( Y11PJP517
tt name m remrtl'n SAterrnf Nan that of app�an;
b dnuaU
arterrt year
I�'.� i
rtnrtgagee ar wntract seder (n�mbel and straet �: sbm. aM LP mde)
tt ovmed
la Ne applksnt ihe sde
legal a equitade ameR
❑ Yes ❑ No
iMi�Se with wlwm
16 Ihe poperty in OuesCOn: MnuaDy Asse55eE
� Real ProPertY ❑ ��Y �
Name of assignee or oMer owner w halder ot mwtgage ___ __ .
Adtlress of assignae (number eM street �Y, s+e�.
9 �
. ... - • ...L...}..
. �
Does appimru awn v�v�Y in am' omer ]� I" 1\\' C I' -� O.•••. •.. Has ihs eeeucrim men requevm m piopelty
couHy n IMiana? ❑ Yes ❑ No '}J I I � for wrteM yeaR
❑ Yes ❑ No
..........
C:1I�Ci � . ..... ..
:� i3,�50. �°� .
Drlluman apprwed in the amount oE '
2b � 20 _ � 20 _ � 20 � 20 _
��
Pi��i:�l
�ate (monfi.
I I We cervfy undes Ne penatty of perjury that Ne above arW toregdng infortnallon is we and correct arid that Ne applicant is a resident of Indiana antl
amer / mntracl buyer of the aforementioned property on date application is fileE.
In�+re (oxnSL5�0 ��) /i � . Date (manfi. daY. Y��
Pe�son auttqi"vee Oy
pe�son (numbereiM sbeeR dry, s+afe, an0 Z!P mtle)
[7
Date (monN, daY. Y��