HomeMy WebLinkAboutMortgage_Cunningham"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
:• $tate Fortn 63709 (R71 / 6-09)
S �.�. P�esaibed Dy DepartrneM of Loral GoremmeM Fu�ance �
INSTRUCTIONS:
To 6e filed in permn w by mad with the CountyAuditor or Counry Recorder o7 the county where the properry is IocatqP�.P R
Filing Dates: 1 J Real Property: Must fJe durir�g the year (or which Ihe deduclion is sought.
2) Mob�le / ManulaUured Homes not assessed as Real Property Mus! file dunrrg the fweNe (12J monfhs
6efora MarGr 37 oteach year Ne daduction is swght. `-yy�
p �!a
See reverse side for addrtro f ins7�ucGOns and quelificafions.
AppGrant (owreior nsee � on m sid w��. . .
Asessed vapie aF �a
Madi 1, w'mt yeer
� d Co /�-o7�aoy- od
Mortpage/ ContraG UNe6tedn�s unpaid a N Mongag
Mard� 7. airteqt year date of.
tt ro, wfial ls his / hu e�U share of Interest? /
If name on re�d o Oilfe2n� Nan Nat d appOpnt, IMipte Debw.
Name N mort8a8' m m�tract setler �y� �
J I � `��
Addrea d mortr�agee u oontratl sr�er (nunbe� erd sbeeR city. s�te. ard e
Name af assignee w atl�u owner m halder of mortgage
PdE2ss of assignee (number ertl atree; dry, sfate, and LP ootle)
Dces aPpli�n[ o.m property in any oNer I( yes. whel countyl
coumy in InOera? 1"i .._ _ f-1 .�_
Counry Auditor
County Remrder
�m7aiE as d Is Ne app0�ni the sde
k9a1 «eWltaNe ow.�eY?
❑ Yes ❑ No
If vamed wiN samew�e other ihan sGO�. irdkate wiM wAnm
Tarirg
Is Ihe propetty in QuesUDn: Mnualty Pssessetl
❑ Real RoPeKY ❑ ?�!�!!�Y �
—__'.�^/�,.o
iraon sPWOred in Ihe artauN of. �Q,Q � yp� Q a h ..
�� .�— �
p_ �_ p_ llra�ti�cr t\`0.,�1,�,DIQ
�
Sig�au�re d Ca�mb a�difur
Card NO. .. �lo��j
� ..............
I/ We cerUfy under Ne penalry of perjury that Ne aL... _. —"��. �
ovmer I contracl buyer ot ihe afaementioned property on date applira➢on is um...
plAant (numDer ane s1re6C pry, atare. ziP mae�
�.mx,�,�-i�, —T
�ewted Powe�oflvtorney w Cy IC 61.1-12-0.7
Address af aWwr'¢Ed person (numberarM sfreet �ry, sbte, enC LP mtla)
stea m propelty
Yes ❑ No
� c�. �r. �d
rdi�
Ne applinnt �5 a resident of IrMiana arW