HomeMy WebLinkAboutMortgage_Nieman"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
__ � FOR DEDUCTION FROM ASSESSED VALUATION
� State Foml 03709 (R77 / fi09j � � �
�' � Presaibad by DepartmeM of Loral Govemment Frence
µ � File Mark
�STRUCTIONS:
Io be �led in person w 6y mail wiN the CountyAUditor or County Recortier o/ the county wher��r�e71y �{}�ated. �� �� �
Filing Dates: 1) Real Ptoperty: Must file dunrg the year for which fhe Oeduction is soughl. �unry Audiior
2) Mobile / Manufectuled Homes rat assessed as Real Property: Must ne dunn e �m'��onths
before March 31 0/ each year ihe deduction is' ��h��`a �' V � Counry Remrder
sought.
See reverse side 7or additiom77nstnictions antl aualilrcations.
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A/3�U 1.MU�I
ra.
name on
his / hrl enU share of interestt
Ihan ihat o( appficant, i�Wirate �ebw
/ �
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N -N,,.
11,5�a�
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'-� � y--eo 3 a�o -p �
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:Ry, slate, aM
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If owned wiN sameorre
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Rem�d numher Page ip��'
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bietlnrss impaitl a of Is Ne epp6rant Ihe eM°
IC[J21 W =QYildCIC Ow11C(�
❑ Yes ❑ No
spouse. iMirate wBh whom
Is ihe property in purst'nn: Mnually AssesseC
❑ Real ProPertY ❑ Mnualy Assessed
_ Modle Hane (IC 67J-7
Hat Na tletlutYnn Ceen reQUestetl m P�apertY
for wnmt YP�� I-'1 ._ I-1
couNn auorroa
DeducUOn appmved in Ne amount ot
20 20 20 20 20 20 20
Signawre ry A Ei r Caunry Date (monM. daY, Y��
1/ We certify urWer Ne penalry of perjury that e above and (oreg � infortnalion is true and cortect arM Na[ the applinnt is a resident of Indiana and
owner ntraIX buyer of �he afwemenlioned-0roperty on date app �on is filed.
SigreWrel o re ) Date (monN. daY Yaah
Wlresidwt otapplinnt numberandsbce4rn3: e.a IP e)
' S PP Z � �N 76 6
Person auUiarizeC by EWy ezecureG Pawer W AtlomeY a bY IC 61.1-12-0 7 Date (monN, day, yder)
Pdtlmss of auNp'se0 person (number ard stree4 ay. sfate, and LPCOtle)