HomeMy WebLinkAboutMortgage_Rahman (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
:r'-_"� ' State Fortn d3709 (R71 / 609)
�' ,,,, ? Presaibed by DePartmerd of LnW Govemment Frence
File Mark
�VSTRUCTfONS:
wM:
To be filed in person w 6y mail wiN Ihe CounryAutlitor or County Recorder o( fhe wunty whele Ihe property is located.
Fi%mg Dates: i) Real Property Must file dunng the yrear for which the rleduction is soughL �y �p�
2) Mob/7e /Manufactured Homes rrot assessed es Real Property Must fiIe dunng the hveNe (72) months
befo/e MaicA 31 0! each year Ne deduction is soughG County Recorder
See 2verse side (or addifional instructbns a d qualifications.
Ap� rorooritra buyer- m mie t�de)
� ,. _g., i9...�. . 7%. „ ,,.,. ,. ,.� c�.m..--�-.,
nssessed �.d�e �f r� a�r as a
!Aa`rh 1, amrld Year
If ro, what 5 h's I her exa�t shara ol
If name m rt.md 5 Eiflerent lhan ft
'W .tJ�"-IC�(�.
Mongage / Contraa 4Mehtedness
MaTh 1.91^e^�_��
az
ci
M I Is Ne appfioni the sole
legal w epudade owne(1
❑ Yes ❑ No
¢s(? I If avmeE vriN someone other Man spouse, indi�ate wNh whom
appGtan4 ��mte Eebw: Is ihe properry in pues0on: Mnuelly Assesse0
❑ Rea� Pmpertv ❑ amua�y wssessed
Name of rrot9a9ee ar cnntrarl seller // ��
�
� vi
Address of trongagee a mntraci seAer (numb� and stroe4 ciN. slete. erN ZIP mCe)
Name of asv�ee or othar awner w twlder M mortgage
MEress oi assignee (number eM saee4 �: s1a1e. arM LP ootle)
Oces applimnt am Pm7enY in any Uhv tl yea, wfia[ munt�R Nrtat
munry in In0'ana? ❑ Yes ❑ No
u�� avv� � � a�
�A µ m�-�, p��-�y �+
�u� �
Has Nis detludion been requesLLW m property
for arrent yea/? ❑ Yes ❑ No
zo_ p �— p—
05-� / I
,�m�e a c�ry Aw��w oac� (�,. aar rEa�
I I We ceNfy under the penalty of pe�ury that tne aa,� o.� _. _„ Tue and mrrect arM that ihe appiinnt is a resident of Indiana antl
owner I wntraU buyer of Ihe aforementioned property on date appficabon is filed.
niawre (awT75�W remel �i �� (^9^�. day, Y��
yfdl riiieent aEtlress ot a t(number antl sbee4 dN �te. era nr oare)
G 7�3 , s �! �Pd G S N� ��.ro� r.v
Pe1mn authaaetl by dWy eze�vteC Povrer of Httomey or by IC 61.7-12-0.7
Address of author'vEd person (num0ererM 5Vee4 �aY. sfafe, and ZIP cotlej
a_ . . ...
DatE (monN. daY. Y��)
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