HomeMy WebLinkAboutMortgage_Mason (10)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,_ _ FOR DEDUCTION FROM ASSESSED VALUATION
�• Sfata Fwm d3709 (R11 / 609)
��w Presfiibed by DepaNrreN ol Laal Govemmeirt Fiiwita
Fle Mark
wsraucnoNS: F
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To be filed in person or by mail with the CountyAudifw w Counry Reoorder ol the oounty wheie the property is located.
F�fig Dates: 7) Real Property: Must h7e dunng the year for which Ne deductbn is soughL ry Aue�r
2J Mo6de / Manulactured Homes nof assessed as Real Property Must file durrng the hveHe (12J monfhs C '
befo�e March 37 01 each year the deduclion is sought ❑ Recorder
Sae reverse side for addiGvnal insWcUOns and qualrfications. (;BSON
MP�m (o �m"�raa E�rye/'sgF lesurt°^y� ie„Trse sidB) /� �l
n�e �n,e a re� �cr � or
n+� i, a.,,P,wa rm
11Q W�1'd� 6 �ILS ��12f GYdCI 5�12f8 Oi YI}PlC5l7
�}lIdR6IX1 RCOfd
RIGICd. I9 EPJOW.
rtufgagee or contrad se�er Imm�6ri eM sbeeC �Y. sbte.
rvame m asvgnee w omer owner w naaer m rtqrtgage
naaress o� asgnee �nurroer ena suee4 el: s+e[e, ana ur coae�
Dces epptirmt wm G�P�Y �n a�7' oNer
munry m Ind'¢na? ❑ Yes �
Deductlon approvetl in tlre a n[ oE G
� �
Remrd numba I Pape numOel
-io v -
ittable mmell
Yes ❑ No
�(OMIIBd WIa15W�COfIC Ofi1Bl I�IdlI5pOU58.
�5 I�G pfOOPlIY If1 QIIRLCII: /NIIII80Y �
❑ Real RopeAy � MnuaDyPSSessed
� Moble Hortie QC 6
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__�eA on propvly
' / COUNTYAI
20 20 20 20 20
Counry Date (rtanth, daY. Y��l
I I We certity undrs Ne penalry of perjury that the above aM foregoing intwmation is W e and cortect and ihat the applirant is a residem of IMiana and
owner I contracl buyer ot the aforementioned property on date application is filed.
���'� (oMnrh hd ^a^'.�? vl i Date (^n^t�. EaY/Ysa�
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auu�aaee oy euN �ewcea rower a atmier w �r �c
pe+son
oate (monfh.
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