HomeMy WebLinkAboutMortgage_Jackson_^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
a FOR DEDUCTION FROM ASSESSED VALUATION
. � State Fo�m 0.3709IR11 / 6-09)
��` Presaibed by Oepartment of Lncal Govemment Fnance
STRUCT70NS:
To 6e fifed in person oi by mail with the CountyAuditor or Counry Recorder of the county where the properry is located.
F�fig Da[es: i) Real PropeRy: Mus[ file during the year for which the deduction is sought.
2) Mobde / Manu/actured Homes rwt assessed as Real Properly Must file dunng the fwelve (72) months
6efora March 37 07 each year the deduUion is sought.
See reverse side !w addifional instructions arM qualifications.
An�nt (awner w cortfraC 6uyer- see restrictiuns on reverse sidej n . \ , r �. S� .
Tabn9 Oistri�. �
Asessetl vaqie d 2a1 D�P�Y at of
March 1, cvm1R Year
I( ro, what a tds / her esad share M in
If �wne m �em�d is diH�� Wn Nat
Address of md(
Nanie af asslg�
Address of ass
Does appFCant
murLLy in IMim
- �{- oa
Mw(gage / Contract intlehtedness unpaid az a( Mongage / Cont
Mart� 1, airten( Y� Oate of apP�ti
-1 bob
If avmed with mmea�re at
3rLL c�difate beb�r.
3ce ar contract seAer (numbe� ard stree(, ciry, stata, aM Z/P code)
w oUrer owner w hdder at mwt9a9e
�(number eM street, ciry. slate, aM ZIP code)
n property in anY �� If yes. what muny?
amw�u or.
wnat iamg traousr
cwn � r wuu� wrt
w r
File Mark
r�
F«,,, mee '
316 ON E�UI�PY"Nl?844Q9R
❑ Caunry Remrder
RecorA number Page numbrJ
301
�mpaid ys d Is Ne app�ont Ne soie
legal w eWitade ownefl
�Yes ❑ No
spouse. ifMkate wBh wt�n /
Is tl�e property in Questim: Ni�waOY Assesud
�Real ProPeKY ❑ �Q�Y �
l 0.bdle Florne (IC G
1 �G S E; ��~ � L
� `y�,,�
/d�s�� �
zo zo _ zo _ za zo _ �� —
Sg�Nre d CamN Auditw Counry Date (rmuh. daY. Nee�
1 I We certty under the penalry ot perjury tliat Ne a6ove and foregoing intormation is we and wrrea and that the appiirant is a residerrt of IMia� aM
owner I conVad buyer of the afo2mentioned property on date application is filed.
,.__�._,_..__;..,_.......� �� _ .0. o�e(7�t/eYt�
futy esewtetl Pm�er of Altorney or by IC G7.1-12-07 I Date
person (number aiM sbeet. dty, slate, end ZIP code) .