HomeMy WebLinkAboutMortgage_Breen.t°•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
? FOR DEDUCTION FROM ASSESSED VA�UATION
� State F«m d3709 (RB I 2-07)
�O � Presaibed by Deparlment af Local Govemment Finance
INSTRUCAONS:
To be frled in person or by mad wifh fhe CountyAuditor o/ fhe county where fhe propeAy is bcated.
Fti'a�g Dafes: 7) Real Property: Dunng fhe 72 months be(ore June 77 o/the yeai fhe deducfion is to be elfeclive.
2J Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 2 ot fhe yeai the deduc6rn i;t04e elfe�i✓�08
See mverse side Ior addifional instructioru and qualifications. N V�
Appiicanl (owner o m r-�e it9friclions on ev rse s0e) � n T� `�'f� ,Q
DisUiq � Keynumberllega
=7 . �, -O/-,
ed value o real poperty as M March 7, wrent y�r
exacl
Ihan �hal of applicant i�diple below:
Name of mortgagee or cantracl seller
1
Address of rtqM1gagee a mnUact seller (ixan6er and slreef.
Name of asegnee a other awner rn hdder of mwigage
Address of assig�e (nurtrber aiM street, crty. state. and:
Dces applicant wm property in any other I'
couny in Indiana7
❑ Yes ❑ No
Deduction approve0 in the amount of:
20 � 20 20
fD-O�a. -�aC-D/�'
I ConUad indeWedness unpai0 as of March i,
If om�ed wiTh someone dher ihan spouse. indirafe with whom.
w equitade v.mef.�
❑Yes ❑No
Is the propeM in question:
❑ Real ProDertv ❑ Mobile Home OC 61.
Drawer NO..a...�..�.�.........
Ha
�(J� I for
Card NO. �
�'1a.95`�,£�'..... _
20 I 20
Caunry
20
uested on property
❑ Yes ❑ No
20
1 I We certify under the penaly of perjury that the above and toregoing infortnation is we and mrtect and that the applipnLS was / were a resident of
I�ana and ovmer of Me atorementioned property on March 7, 20
�natu (owne/s hdl name) � . � Data (monfh. daY.Y�/)
cily. s@(e, and LP
fuy �eated Power of Al�mney w by IC G7.142-.07 I Oale (month, day, yea�
persa� (nom6erarMsbeeL aty. stafe, a�MZlPmde)