HomeMy WebLinkAboutMortgage_Shoultz"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ � FOR DEDUCTION FROM ASSESSED VALUATION
� Sfa[e Fwm d3709 (R77 / 6-09)
�' f Resmbed by DeparlmeM W Local GovernmeN Fuiance ..
INSTRUCT70NS:
To 6e filed in person w by mail wiN the County Auditor or Counry Recorder o( fhe county where the property is located.
Filing Dates: 7) Real Property: Must fi(e durrrg the year for which the deduction is sought.
2) Mob�7e / Manufactured Homes rrot assessed as Real Property Must �le dunng the iweNe (12J months
before March 37 of each year the deduction is sought.
See Ieverse sida /or addi�ional insVUC7FOns and qualificafions. . . � G
ed va4ie d r� pmperty a d
1, nrrent �ear
I( ro, whal ¢ his l lrer e� share Of interesi?
File
Auditw
r/legaltlesmptim I (f Reco�d P�pe pj?��
� • v� 1 \.
Abrtga9e / Contraa trdeb ness unpaid as W Mortgage / ConbaG inEe6tedness unpaiO as a( Is Ne appfirant the sde
Marti� t, w dare of applxatnn legal or equilade ame!!
���, %�� ❑ Yes ❑ No
It rartie m remrC is tlirterent Nan Nat o( avP�^�. m0ipte below.
mort9a9ee a convaa
contraG se0er (number aM sLeeS
Name of assignea w ahei awner ar hdder ot mortgage
(num0er eM sfrec{ tlt}; sYdte, and LP mde)
��
tt ownad wiN someo�re ottier tlan spouu. u�dicate with vnmm
Is Me p�operty in QuesCOn: MnuaDy Assesse0 �
❑ Real ProPeKY Q Armually Pssessed
, w.wie w�..,o nr a.�
J�4�U�T2 BRrna i'��
C I�- A(Z L O�iT� L
v �1-0��1 I I ���� �, P�
❑ Yes ❑ No
COUN7Y AUDROR
Deduction approved in the amount ot
20 20 20 20 20 _ 20 20 _
Sigitature of CamryAUdimr Counry Date (mmth. tlay, yra�
i/ We certify uMer the penatty of perjury that ihe above aM (oregoing infortnalion is We and cortec[ and Nat ihe applinnt is a resident of IrWiana aM
owner! contracl buyer of the aforementioned property on date appliption is filed.
�' Ntl na ) '" Date (monfh, daY• Y��
resident �t 6er str�e(. dN te a 21P ) •����
S
Person auttrometl Ey duy esecuted Po«er W At[omey w Cy C F1. f-12-0.7 Date (rtiunfh. tlaY. ri'3�
Addressofauthavedperson(numberaMstreet,city,sbte,aMLPCOtle) .