HomeMy WebLinkAboutMortgage_Chamberlain (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION _ -�--�
Stata Fam 03709 (R71 / 6-09) !� •,�
�,�,� � P�rsaibed by DePertmeN of L�I Govemmerq Financa � '�
�, "°�I�C'�
INSTRUCTIONS:
To be ned in person w b mail wiN the Coun Auditor or Coun Recorder o! the coun where the ro u located- F� �� ��
r b b b a ce�h' �...:
Fitirg Dates: i) Real Pioparty: Musl file durirg the year for which tha deduclion is soughL Counry lwditor
2) Mo6Be / ManufaUUred Homes rwt asseued as Real Property Must file dunng the tweAre (12J months 11
6efae March 37 0! each year the deduction is so,ghG CF-�1 nry Recorder
,.J � ti--� r'
See revBrse side (uraddttionel in57iuctbns and quelificafiona V._„ ,,,,,,r,�Q
�i..l"•`T
artent
H name m �emtd'a dRterent than tliat of a7P��t'oNCam Eebw.
Name W rtnrtgagee a mntracl xper
AGdress of nnrtgagee v mnbaU x0er (numGer antl stree4 c4�', s}ate.
Name of assigiee or dtv wnws m hdder af mortgaga
AEdd
Does
cauM
— Dra�ver \`0 ................
...
oea�a T .... ��li�.�...
Card i`�O.
n � ��1 �Q .W
sigrem.. _. _......> ..,.,wr
101-Ob0
O LJn��
� U owne0
Wtal Ta�dng Districl7
zo i zo
unPaid a d La Ne aOP�t the sale
legal w eQWta61e ameR
❑ Yes ❑ No
aher Ihan sPa+�. irMkate with Mrom
Is Ne piope+ly in puestion: MnuaAy Assessed
❑ Real ProPettY ❑ Arwiaiy A�ssed
�urmm Deen re7uc.tea m ptopelty
�n ❑ Yes ❑ No
zo zo
oa�e (rt,ow,. ear. r��
I I We ceNfy under ihe penalry of perjury Mat the above and foregoing infortnalion is We and cortect arM Nat ihe applinnt is a resideM of Indiana aiM
owner I mntracl buyer ot the aforementiw�ed property on date appiication is filed.
RSiCent aCEr¢s W
and stree4 �l: s+afe,
�Zr
Pe�sm autlwr'¢ed by 0Wy
by IC 61.14
person (numOer aM sbeet �: slate. and ZIP mde)