HomeMy WebLinkAboutMortgage_Minkler�'*a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ip ��Y'i
FOR DEDUCTION FROM ASSESSED VALUATION �
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Slate Fwm d3709 (R77 / 6-09) .
�` y,� Prestribed hy DeVaM�M of Laml Govemmerd Rnatce � �op,u�
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�S7RUCTlONS: _
Fortn filed with:
To be lled in person or by mail with the CountyAudifor or County Recorder o! the county whe2 the propeAy is located.
Filmg Dafes: i) Real Pmperty: Musf �le dun�g fhe year Por which Ihe deduction is sought. 6�� Coun utli r
2) Mo6�7e / Manu/actuled Homes rrot assessed as Real Property: Must file during fhe twelve (12) months n � M
befae Mamh 31 ofeach yearthe deducfion is sought IBS6A CODUaTY OR
See 2verse side (or addiUOnal insVUCtions aiM qualilcafions.
AppGcam (owner ar contrdC 6uyer- see re on re sife)
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Tari�g Oistrirl Key �wmber / iegal desaiption Rerantl rwmErJ Pa�e umba
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Assessetl value d real pioperty
Me�r�h 1, amaM yrar
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tt no. what is ttis / trer euG
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Y
Nan Nat of appGmn4 HL'uate Debw
Name of rtrortgagee or mntract seller
T 3 3 �T
ndaress ormort�agee «oono-aa seu
Name o( assi�ee u othe� owner or Y
amress
act'udebtedness unpaid as W Mwtgage / Contract intlebtetlness unpaid as d i Is Ne applirmt Ne sde
year date of appGotion '� legal w equitade rnmeR
7,Q1� ❑ Yes ❑ No
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stree4 mY. state. ard Z/P mtle)
limnt wm property in anY other I If yes.
Intlana? ❑ Ye5
❑ No
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Synature ot CounN Aw
If orned wich somrane otM1 than spouse, indicate
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unl�/? lMiatTanrgDistncl?
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b
e propeny in Qurstion: MnuaP/PSSesseE
Real Pmperty Q Mnually Assessed
Mobile Home (IC 61.
Has ihis AeCUd'an Oeen re9uested on P�W�rtY
(or wrrent yeaR ❑ Y� ❑
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I/ We certi(y under '�����---•.. e� a roregoing intormation is true and cortect arW Nat the applirant is a resident of IMiana and
owner I mntract bu .. .� a�wementioned properry on date application is filetl.
� ^ wner3 fl�navy�e}� )„ Date (rm�C�. EaY Y��
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fl resdent aEdress of appGrant (numbe� an0 sLeet slafe, and P mr/e
+„�=-A��O Gr�.,..� � t 2� �76 rF�
rson au ed Gy duly ez tetl Power—� — W Att eiro�� IC 1.1-12-0. Date (month. day, yEa�
Pddr¢ss of a Wroraed persm (number aiM street ciry, state. and Z!P m0e)