HomeMy WebLinkAboutMortgage_BrittinghamSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
N: FOR DEDUCTION FROM ASSESSED VALUATION J
� State Form G3709 (R71 / 6-W) (/
,' Prescibed by DepartrneM uf l.ocal GovemmeM Firwke
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INSTRUCTIONS:
Fartn filed with:
b be filed in person or by mad with the CouniyAuditor or Counry Recorder o/ Ne counry whe�a the poperty is located. J U
Filirg Dafes: 1) Real Property: Must tde durirq the year (or which the deductan is sough[. unty Auditor
2) Mo6de / Manutacfured Homes not assessed as Real Prt�peerly Must fi7e dunrg the hveNe (72J monMs ❑
befora Maich 31 0( each yEar the deduUiar is sayht. Counry Recorder
See raverse side Iof addiGonal insWCtions and qualficafions.
npprxam( owwa�7byp,r-see ��de) , , � _)_ CaIBSON COUNTY AUDITOR
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tt nama m remN b E'ifferent Nan Ihat N appOCan; ud'xate belrnr.
Nama of rtnrtgagee ar mntrarl se�ler �
Pddress d nartgagce or mntrad se�er (num6er and sbeet ciry. smm. aM LP
Name of assignea w dher ownel or halder of mor�7a9e
AAC�avs o1 assignee (num6er artl sbeeL �Y. slate, antl Z/P oode)
O�MnY � a^Y �
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Or�u�an u� � �-- �'
zo Card NO. ...(•�I..—�.�.......
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/cdntracl
(ownerYfu
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ntatldress
Po�vg
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s unpaid as o
S-O/ U �' l5 `
igega I Contraa 4Me0tetlnen unpaiE as d Is ihe ePP��t the sde
f of aOP�� legal or eQUitade axmM
❑ Yes ❑ No
wmeme oNer tlan spouse. IMrcafe wtth wMm
Is the property in Question: Mnually Asussed
❑ Rea� Proaenr ❑ nrmua�yw�
I What Tavng Distr'r17 I Has Nis tle0uction d
for w�ren� yea(.�
)UNTYAUOROR
20 _ 20 _ 20 _
the above and (o2going infwmalion
property on daffi appfi�ation is filad.
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antl LP cotle)
:lea m ptopelly
Yes ❑ No
�
cortecl and Nat the appiinn[ is a resident of InAiana and
Data (nmth. daY. Y�A
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