HomeMy WebLinkAboutMortgage_Beard"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
� V-�..
; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn C3709 (Rt t/ 6-09)
� w. � ��� M�Pa�� of L.oml GovemmeM Frence
�VSTRUCTIONS: �
ib 6e filed in person or by mail witb the CoanryAuditor or Counry RecoNer of Ne counry where the pro e4rty �
Filirg Dates: i) Real PropeRy: Must file during fhe year /or which fhe deductlon is sought.
2) Mo6ile / Manulactured Homes raf assessed as Real Prdperty.� Must fiie dunng the (wefve (72yqpqt/tJ
before March 31 of eech }rear the deduction is sought. j' C.D
See reverse side /or additional instruclions aiM qualilcafions.
MP��N74�+����7�A�YlEn-seere mreverseside)
a�a�w��enyasa
Ma�di 1. aerent year
If no. what ¢ his / her ezaU share of intemsi?
If rwne on recmC a 61fe�t Nan Ihat of aPpG
Name or mortgagee « m,vact seueC�
�3
Pddtess of fmtoaoee w mnbact se�er (nwN
�=i�s="z6Z �o �Sa o a
Mortga9e / Contraa'uWebtednc^s unpaitl as of MMgage
MarU 1, wrtent year date of ao
beb�r
and stree; ray, sfafe. ald ZfP code)
Name of asvgnee or other owner or hdOer of nwrtgage
AGdmss o( assignee (numDer e�M sf2e4 ary. s�ste, aM Z/P code)
property in any oUn � It yes,
Counly Auditor
Counry Recorder
Rttord numbet � � Page
H owned xiM saneone ather than spouu. iMkate wiN wMm
w equltade ovmeY!
❑ Yes ❑ No
w�{uoPMY in 7uesGOn: MnuaOy A1ses5ed
Re� a�oaenr ❑ a,�,uaiyw�d
What Ta�ong DisUiG? Has N4 dMudion Oeen repuesteE m propeny
forartentyeaY.� � _ � .
COUNN AUDROR
Deduction approved in ttie amount of:
20 20 20 20 20 20 20
SignaN2 0( Counry Audiwr CounN Date (rtaNh. EaY Yea�l
I/ We certify under Ihe penalry of perjury that the above and foregoing infortnation is true and mrtea and Nat ihe applinn[ is a resident of InCiana antl
owner I mntracl buyer of �he aforementioned pro rn date appliration is filed.
reme) Date (monfi. daY. Yaa�
FW aEdress appfxant (nu Dar nd sbaef. '. sfate, a ZIP<m�ej7 . ����
/ %�v✓(
i
Persm auNwaed by CWy erewreE Power d Atlomey ar Cy IC 1. 12-0 7 Dale (r+pnM. day, yae�
Pdtlress N a�Uror'vEd pe�son (number eM saee4 dry. sbre, and LP mde)