HomeMy WebLinkAboutMortgage_Baim'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
� Sfale Fortn C3709 (R71 / 6-09)
. �• ,�,� f p2smbed �y D¢PaM�N O(LOWI GOVemmenl Fnaxe
� INSTRUCT70NS: 000���qq���dddv�m
To 6e filed in person or by mail wiN the CountyAuditor or Counry Recofder of the counry where the property is located. F l F t' �q � 2��2
Frlirg Dates: 1) Real Pmperty: Must file durirg the year /or which tha deduction is soughL � County Auditor
2) Mo6Be / Manufactured Homes rrot assessed as Real Property: Mus! fi/e during the lweNe (12) months �f-1
before March 31 0/ each year Ne deduclion is sought 't7 �� � �
See ieverse side for additional insVUCtions arrd qualifications.
AppGrant (o or corlt+aG bN'er - see resnictiwss m reverse '
�istrm y rvunber / legal tlesviption RemN rnmEC Page number
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rc no. wha� a na / tcer e�ct shart
Man iha� al appMent. trMirate below.
rlartreor onqayea«cairaasel�er
Address � ee w contratl sW
Name at assignee w ahu awrrer w h
Aearess oi assgnee (nurtNer and am
Dces apqira�rt own WoD�r in e�y wher
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munty in In0'a�u? ❑ Y2s ❑ No
Deducfian aPProved in Ne
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LPcode)
If yes. what munryR
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What Taring C
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Sig`ature W Counry AuAitor Caunry Date (rtonN. daY• l�A
1/ We ceNfy under the penalry of perjury that the ahove and toregoing infortnation is We and mrtect and that the applicant is a resident of IfMiana arM
ovmer I contrad buyer of the aforemerttioned property on date applicatlon is filed.
T��1 �'i�.V J- � I / 1 1 Dat° (nnnm. dai: i�A
Date (rtanlh. daY•
person (num0erarM streel, dry, sfate, and LP code)
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