HomeMy WebLinkAboutMortgage_Clark"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
:__ .� FOR DEDUCTION FROM ASSESSED VALUATION
• Sbta Fam C3709 (R71 / 609)
S�.�. 1 Presmbed by DePa�rd al Loml GovemnreN Finarce
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To 6e Ried in person or by maii wiM the CountyAUditor or Counry Recorde� of the county where the pmperty is located. .
Fitirg Dates: i) Real Pmperty Must file durirg the year for which Ne deduc0on is wughL � Counry Auditor
2J Mo6de / Manufactured Homes rat assessed as Real Pruperty: Mus! h7e during the fweHe (12) months
6efo�e March 31 of each year the deduclion is sought. � �Ceunry Recorder
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Seereversesideforadditionalinstrtic(ionsandqualilcafions. - ,.,,,�r,., rnnuTY Al1DI70R
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If �w. what 6 his / her exaU share Of interesi7
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nbaa indebceEnnss unpaid as of Mortgage / Conba
n( year tlate of appfication
tl fwrie m �ecad's Eiftefan than that W aDP�t uMirate bebv�
Name ot mutgagee w mntraa
mort9agee ar wntraG se0er
Name of assignee w WirJ owner or hdder of matgage
naaress o� assg�e {nunicer a�w suec; my, smie. am
Does ePWifant a.m yoperty in any oNer
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erty �lYnlUallyAssessed
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I/ We certify under ihe penatty of perjury Nal the ahove aM foregning infwmalim is We and cortect arW Nat the applirant is a resident of Ircfiana arW
owner I mnhact buyer of ihe aforemerrtioned property on date applicalion is filed.
ard street, dty, state, ard Z1P wde)
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� I P�ison auCaiueE Gy O�ily eaecuted Pw.er ot Pttm�ey or by
person (numbereM sbeef, c4y, stafe. antl LP cotle)
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