HomeMy WebLinkAboutMortgage_George-^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
; FOR DEDUCTION FROM ASSESSED VALUATION
Siate Form d3709 (Ril / 6-09)
�' ,�,� � Pasvibetl by Departmerd of Lnml GovemmeM France
INSTRUCTIONS:
To be lled in person w by mail wiN the CounryAUditor or Counry RecoNer o/ the counry where the property is located.
Filing Dates: i) Real Pmperty: Musf !le dunm� fhe year /or which the deducLOn is soughf.
2) MobBe / Manufactured Homes not assessed as Real Propetly Musf file during the hveNe (72) months
6efore March 37 0/ eadr year the deduction is sought.
See reverse side for addi�ional instructions and quali�cations.
MP�k(ownerormqhartbuye�'seemslnc0onsonreversesiie) _
1 rea1 PmpenY az
year
If �rtie on �ewrC is d`tttterrst Nan ihat of a0p6cant, mAicate Cebw.
Name of mortgagee a conttaU se4er
Pddress oi rtnrtga9� w contraG
owner
rode)
(number aM aLeef, ary. sfete. and ZIP cotle)
Does applitant ovm property in eny oUer
counry in Ind'ana? n
zo
signanne
�
I/ We certify urWer the penalry of perjun
owner I contrad buyer of Ne aforeme�rti�. �..
wewtP.fo�Q�rsfi�uremeji �
auttmnzed
Y�.
-01
��
Recorder
d Is Ne applirant the sde
legal w equibde ame(.+
❑ Yes ❑ No
If ownad with somea� other Nan spouse. ildimte wdh whom
a�......
D,��„��►� �o........ ,
. . . 'SS�I
Card ��• � i5a,�p' Q'�
execureA Power ol Attwney m by
De�
Is Ihe property in 9�: �nuaDy Assessed
❑ Real Property ❑ P.nnuallyAssessed
Has Nis tleduUion Eeen requested on property
far curreN yea�?
❑ Yes ❑ No
zo _ � zo
o-d� (�r,�,rn,
__.��y m�ortnalion is true and cortecl a(W Nat the applinnt is a resident of Indiana and
on date application is filed.
Dare (month, day, yee�
an0 LP oode)
Date (monN, day, yee� .