HomeMy WebLinkAboutMortgage_Hillebrandt°"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION ��
Slate Form 13709 (R70 /71-08)
` � Pfas�afbedbY�P3M�enta(loralGwernmBMFrt�anm
iNSraucnoNS: ��N 1 ��`7MZ009
To be fded in person or by med with the CovntyAuditor d the �ounty where the poperty is bcaled.
Fil'vg Dates: 1) Real Property.� Must Poe during Ne yoe� lw whirh tlre deduction is sought.
2J Mobde / ManuleUUred Homes not assessed as Real Proparty: Must file dunrg tlre fweNe (12) mon MarcA 3,1y / each year
fhe Deducfion is ht /�-�
Seereverseseeforeddaiona�insWdionsandpualrfications GIBSbN rrn� � �.11..��,,..
' Ma�th 7. amerti Yea .
Y m, whal s his / her eaad share d i�iest?
u mme o� remra is G�amm uwn uiat w avo�
Name d mMgagee a mntmG se0er
nddress d rtor(gagea or c«a2a saoer (rnm
/ legal Eesfnp(nn Record nwnber
- �-o _ o _�oo o6-oaa�
Aort9age / inOebleErress u�aid as d Afortgage / Cavrazl indeWednass unpaid az d I
Aart3� i. rurteN year dale of appfimtion I
/ �^ ��
I( amed wiih someore aahar Uan svwse. iMicate wifh whn
Nama d essigfrea or Wher owner a hoider d matpage
,��a��,�„�,��. �: �m. �
belvw:
sFaln.
!'age num0erC l/
� � T
�CO�d Q�e sala
Q aO�aGle awne(!
❑ Yes ❑ Na
Is me v�M in auesfon: n`w,ah wwssea
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Dra�vcr NO... abb........
i a�t
CaTd NO . .....................
�K I 5, Oo� � ,
yes..mat ca,my? � w� iawp oamd7 � na, uus aaeudion oeen ram,estm a, �aoeM
couNn nuwroR
Deduc�ion apprwed in Na artaunl d:
20 20 20 20 20 20 20
P- - - - - -
Sipnawre Cou�dy nuditar Camry Uate (rrmth. day, yr+ar)
I/ We certy urM� [he Ity of perjury that the e ard foregafg mfamatim is We and cared and that the apptfcant is a resitlent of Indaria aM
owner I contred buyer of the aforementbned pro rty on tlale aDD��� �s filed.
na (anirfs h/ J � i Date (ma4h, day, year)
Full identaddress a�fant(mvnbererW �,andLPmdo�
� a�� ��� � � 66
Persm aulhaaed by duty aseaimd Power d Acbmey w by IC 61.1-12-0.7 Oafe (rmvA. tlay, year)
Address d aulhorized person (numDtr and she0t, dty, ffito. anE LP raM.)