HomeMy WebLinkAboutMortgage_Luttrell (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun owns ' ear
__ = FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Form 93709 (R71 / 609)
` � Presaibed by DepaRmenl of Loral Govemment Fnarxe
II
INSTRUCiIONS:
To be h7ed in person w by maii wifh the CounryAudiror or Counry Recorder o/ the county whem the pmperty is located. °
Fili,g Dates: i) Real Property Must file dunng Iha year for which the deduclion is sought. ���
2) Mobde / Manufactured Hwnes rrot assessed as Real Property: Must file during the tweHe (72) month���s N C�1 N�'����
betore Maich 31 of each year the Ceduction is sought.
See reverse side lor additiunal instrucLOns arM qualifications.
AooGpnt (ownei or convarl buver- see rcshictions an reverse sidel � n
isIIict ' Key fum�6er / legal d�aiption Record numbrl Page mimbu
a -o _�Y= 3oc�-noo.o�o-oao do l 'i5o8
I ralue d mal propeny as ol Mortgage/ Contract iMehtetlneu unpaitl as of Mortgage / Contrad irWebiedness unpaid as d Is Ne a0d�t Me sole
a+rent year MarU 1, wrtent year Cate of applrcation legal w eQUitade wmeY?
7- S �� 3 ❑ Yes ❑ No
ro. wnat a itis! trer erart snare or
nait�e
Name of mortgagee w
Address W mwlgagee or mntrad se�er (mrtn6er aM sfreeL uty. ffite. aM i
Name of assignee w other owner or twlder ot mortgage
ACCress of assignee (number eM stree4 �y. slate, and LP cade)
EN �
Does apptirent wm pmperty in any oNer I( yes, what munt}�1
munry m InOiana? ❑ Yes
❑ No
amount
20 � 20 _ � 20
I I We certify undu ihe penaly of �fjury that the s
owner I contract buyer of ihe afo'ementioned prop�
� Sig��un/ue (ownefs hd �me) L
h�1
Full resitlent atlOress of applirant (number antl t, dry 51
E
Pe�son authar�d by dM' ezeated Pawer o(AUpney rn Cy
person (num6erarrdstreef,dty,sYdfe,
20
someore oNer Ihan sPOUSe. uMicate wiN whom
What Tari� DisViU?
20
k Ne perty in QuesUan: Mnuelly Assessed
Real PmPenY � ��a�Y�
Mobile Home (IC 6
Dra���ei• NO...��:`.........
Card NO. .����........
�1�� .�5
20 � 20 �
day,
nd foregoing intortnation is We and cortect arW ihat the applinnt is a resident of InE�tana arM
date application is filed.
aM ZIP ootle)
7
oaee ema,m, ear: r�n
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