HomeMy WebLinkAboutMortgage_Scott (6)^� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
__ s FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 93709 (R11 ! 6-09) � � � � T
•�' ,,,, I Presaibetl by Departmerd ol Laml Govemment Fu�ance , e
I�
�STRUCTIONS:
To be filed in person a by mail witlr the CounryAVditor or Counry Recorder o��l�/ wl�fhe propf
Fifing Dates: 7) Real Property: Mus! �le durirg the year for which the deducLOn is sought.
2) Mo6de / Manufactured Homes rat assessed as Real Prnperly Mu�St h7e unng the lwelv
6e/o�e March 37 oteach year the deduction is soughG �" �-
See reverse side �difional instnicLOns and qualificafions.
MMrant(owfkr bure�-seereN+N+�ccbans versesvel . C'�S9li Ef-^,��p'�UDlfOR
�����
If rw. wha� fs his / her exact share ot interest?
If narna m remN a dilfe�mt Nan that d app6cant, uMitate Eebw.
Name af nnrtgagee or mntraa s�
Adtl2ss of nongagce ar cvnbact
Name W assic,piee w othei awner
shee4
s�t.�o.oya-oa�.
AOCress ot assignee (numDer an �v � �� -
/
oces aoo�o� rnm c�cenr � �.1�i�%�} �
munryinlMaru? ❑
����%//
oee�aon apprmrt.a m me arm,n[ a�.
20 _ � 20 � 2q _ � 20 _
F?...v'"'�.�'�
ca,my
Coun Tovmship Year
File Mark
Form t�ed with:
� is located. �'q�
f2)months u �ntyAudimr
❑ County Remrder
Recortl number Page number
1 r �8ii
���� ����,��
legal w eWita6k amM
❑ Yes ❑ NO
Is ihe praperty in Vunstion: MnuaOy Assessed
❑ rtea� Pmpem ❑ annaly assessea
for
20 � 20
o�e (momn. ear r�d
m property
n�
2b
I I We certify under ihe penalry of pc�Gry that the abov�nd foregoing infortnation is true and cortect arW Nat ihe apD���nt is a resident of Irdiana ard
owner / mntracl buyer of Ne aforementioned property date applicatbn is filed.
�rewre wnefs fiA pertre) � Date (rtmth, daY. Y�)
O M /. G2.y
II resident aGdrass of appf�cant (num rand sLeeC tlty, stete, and ZIP mtle) /, �� n �.
Pasan auUiorrzed Gy dWy
U
Po�wJ af Attorriey w q
(numberaM sLeet. tlry. stdte. aM ZIP code)
l,U