HomeMy WebLinkAboutMortgage_Beard (4)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
:__ + FOR DEDUCTION FROM ASSESSED VALUATION
• Sta[e ftrm C3709 (Ri1 / 6-09)
, w. � Presvibed by Departmerd of Laal Goremmerrt Frence
INSTRUCTIONS:
To be filed in person w by mail with the Counry Auditor or Counry Recnrder of the wunry where the p�operty is bca . F
FiTing Dates: 1) Real PiopeRy: Must file dunrg the yea� hr whith the derluction is sought
2) Mo6de / Manufactured Homes ra( assessed as Real Property: Mus[ file during the tweNe (72) mo� C q q
before March 37 of eadr year Ne Ceduction a sought �+ O
See reverse side /or addttronal insfructions and qualifications.
Apptirant o roroonfraC6 �-seereshictions rse ' e) ��x., ��
Gk
' 9L ci6so G
�T ��9 KeY rctm0u I epal ae5aiptlon
a�- � �o -oo /. C� 3- oa �-,,
Asseaed vahu d rral p'apery as of Mortgage / Contract'uWe6w�rress unP� az W Mortgage / Contrart iMebtetln¢s �mV� az d
Maid� 7. artart year March t. n�rtem yyar � tlate of appfration
n no. wnat 6 t� I tcer eracl st�are
If name on 2cnN a QAterent Ihan
Name of rtnrtgagee or contracl se0er
Address of maRgagce w wntrad seAer
Name af assignee w dhu wmer or hd
Dces epplzaM own ryoperty in any oNer
munry in Ind'ana?
❑ Yes
DeducCOn apprwed in Ihe amount of.
ber end sbea; city, s�tafe, arid LP code)
rtqrtgage
state, eM LP mCe)
I( yes, what mum/?
I No
Year
County Auditur
Caunry Recader
Yes L� No
SWUSC. YWIC2I8 M1GI �Yt1om
rIs oCi.e, �p,m�D�Y� i�n'Gu�esGOn: MmiaM Assesse0
/ � MOble F� (IC 6
/��2D, VL� � 2 D -
1/LL� KS� L
�loi� / ! W
I � ❑
�
20 _ 20 20 _ 20 _ 20 2q _ 20 _
Signature N Camb Ntltta Counry Date (month. daY. Y��
I I We certify under �he penalty of perjury Ihat Ne above and foregoing infortnation is We and mrtec[ arW that the applirant is a resident of I�iana aM
owner I wntract buyer of the aforementloned property on date applip0on is filed.
�9�P� (a�T�9�e /� �Hme) _ � Date (mrnCi. daY. Wa�
FWresident
and ZIP
PQrsdn authw�tl Ey CWy executeC PowrJ a(Aitornay w Cy IG 61.1-12-0.]
Atltlress of aWmraed Ge+son (numhe� aM sDee4 ury• sfate, ard ZIP oode)
�Y. Y��
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