HomeMy WebLinkAboutMortgage_Stevens (3)"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_. FOR DEDUCTION FROM ASSESSED VALUATION
� Shata Fortn d3709 (R17 / 6-09) v
�,.,. PrrsoiCed by DePa�rd ol Loml GoremmeM Flnanca
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INSTRUCTIONS:
To 6e filed in person w by mail with the CountyAUditor or Counry Recorder o/ fhe rounty where the properry is located. S�m� '
Fifhg Dates: 7) Real Property: Must file durirg the year for which the deduclion is sought. � Counry Audimr
2) Mo6Ae / Manulactured Homes not assesced es Real Properly Must file during Me rtvelve (f2J months ❑
6efwe March 31 of eadr year the deduction k mught. �$Q�-B�Y R��
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See reverse siCe for adtlifional insfilctions�and qualificaUons. T V AU01ibF�
@�Se!' 68�l+)
��^�(�W�'�9YY��6✓Yw:iee mreverseside) T I
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arrem year
If narne m iem�d a NftMa�t Nan that of aPpBCant u�tlirate hebr.
r+a� m �ar�e�
mortgagce m m�trad
Dces ePplirant rnm praperty in any oNer
tounry m Intlie�? ❑ Yes
F,:
SignaDUe
�
r�y, s�re, an
ara
i.�'iR`u'7
az ot I Mortqage I Con:rerl trWebtedness unpai0 as d
dam af app�tation
tl ownad with mmeone other than spause,
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c�,�t �
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Caunry
ritable aHneR
Yes ❑ No
Is Ihe V�OenY in QuesSOn: MnuaDY Assessed
❑ Real a'oaenv � /��M �
a�onae rro� nc ��.
Nas Ih¢ deductim Eeen re9ueste0 m P�Y
�� a^em y�r n .,_ _ n
�— � �°—
�y,��
I/ We certify urWer the penalty of perjury that the above and foregoing infortnation is true and cortect and Nai the applirant is a resideM of IrWiara and
owner I mntraG buyer of Ne aforemer�tioned property on date application is filed.
7naGUe (owneh hN reme) � �(+�. daY• Y��)
sf2te. an0 ZIP mtle)
Mdy rseated Power of AtbmeY w M IC 61.
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