HomeMy WebLinkAboutMortgage_Newcome� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n wn ip Year
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
.• Stata Fortn C3709 (R71 / 6-09)
,' ,.,. Presrribed M �eDa�nt oi Laal GovammaM Flriance
File Mark
INSTRUCTIONS:
F ed wiih:
b 6e (rled in person or by mail with fhe CountyAUditor or Counry Recorder o7 the county wl�ere fhe properry is I 6 �, r�
Fi6rg Dates: 7J Real Property: Must ke durirg the year /or whifh the deduction is sought. � County Auditor
2) Mo6�le / Manufactured Homes not assessed as Real Property: Must fi7e dunrg the fwefve (3��@IQi�OU T Y DI'���, Recorder
6efwe Maich 37 of each year Ne deduction is mught.
See reverse side 7or additional insWCGons and qualifications.
Ap nt (owrei a ow�traC b - see resLirliorts m re�nrse sitle)
�
Tax'ug Distrrcl Key nmCer / legal desaip6on ReraN number Paga number
2��-��-la- ao�/-o00.5 3-0� o O �
Asesse� vahx d rnal uooatv as of Mortaaae / ContrarS'udebteanass unuaid as of Mortaaae I Cmtra� hWebteAness unoaiE as d Is Ne epplirant Me sde
Matlll.Ql�P1tt)YL/ IM2IfT�� �
I
rc no. �� r� n�s i�. e� � or ���n
M name m remrd'a 6fterent than tha� of apP�t indifate beb.r.
Nama of nort�gee m m�ttari sWer �/ �
AOdras of nnrcjagee ar mntracl se0� (nunber and sheet �Y• .sb�. e
Name o( azsignee or Whc wmer w halder d nwrtgage
Y% N
Ikant wm praperty in any oNer
Ird"ana? ❑ Yes
DeAuctian appmred In 1tre amount
20 _
Sigreuae d Cmmd AuEitcr
I/ We certify und th�
owner I mntra uye
,?o a E' �
Person autMRed
ciry, slBte. arM LP aotlej
'� '02 -.3-/ <
It yes. what munty?
❑ Na
2tl _
pena—dJ n_k
of Ne atore�l
.,:,°--� , ��
legal ar eqWta6le owne(?
❑ Yes ❑ No
�. �,a�� �n, �,
Is the property in puestion: Mnua�y Assessetl
�Real PmPert�' ❑ :Oimualh' Assessed
♦'� �' � : .
NTat Tariig D'str'vY? Has Vus
far ame
��7
COUNTYAUDRC Dl�a}}'��•,'Q.....�(��U
20 20 C a (' C� �� 0. . . . . . . / V � —
..�...... —
�"" � �B �/ �50. c� —
I
Ne above and foregoing infortnation is We and mrtec[ arid thal the appiinnt is a resident of I`Miana and
pruperty on date appircation is filed. -
appfxant (numDerantl sLeet. tlry, stafe.
a cy
person (numberaM sbee4 ary. sbfe, end LP code)
�� c�. �r,