HomeMy WebLinkAboutMortgage_Davis (39)-"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Counn
FOR DEDUCTION FROM ASSESSED VALUATION
Sfata Fwm G3709 (R71 / 6-09)
� Presrri6ed M OeC��� of L.o� GovemmeM Firence �
INSTRUCTIONS:
To be filed in person w by mad wiN Ure Counry Auditw or Counry Recorder o/ the counry where the properry is �
Frtirg Dates: 1) Real PropeRy: Must file durrrg the year for whirh the deduction is wughG
2) Mo6de /ManNactured Homes not assessed as Real Properly Must file dunng the tweNe (12) months
before March 31 0/ each yenr Ne deduction is saght.
See ieverse side 7or addrtional instnrctions eM qua/fications.
A70��� (9��arm�traC buye/' ue resfirf,bns m rere�p9�iCe) o
d real pfoperty
,�'SF^.,.j
u
Name m rtql�gee ar ca,o-ati seo«
Mdr� d rtartgagce u oontrar� sr�u
Name of assi�ee or oMe1 awnu m hd
AdCress of assig�e (numher ard st�ee
Does ePplimnt o+m pmperty in any oNi
munry in InGiana?
❑ Yes
D�umon approved'e� tlre amount at
- o� -i v r -
ortgaga I Contra� ebted
Mamh 1 airtent
est?
appOCant, tr�difate bebw.
� I
nixnber end streeL �y: sta+e. ard LP
e�amm9a9e / YULLSII/
tlry, smte. end Z/P cada)
If yes, what muntyl
❑ No
gs��a,��
Counry Recordu
_ 60 . --- �o �73�
as of MMgage / ContraG InOebtetlness unpaid as ol Is Me aDO��t tha mle
tlaro of appacat�on legal a eQWiade ow+icY7
❑ Yes ❑ No
'' owned wiN wrneone oNer ihan spouse. mdKate wtth wfnm
Is P�P�Y in aursnm: Mn�eM ALSesuE
Real Pfopelty � Nmually AssesSed . . .
NTaI Ta�dig Distrirl5
Dra�ver N0.4��•�•�.........
c�ra �o. ...a.7�.5.........
� 75;3�0 .�—
20 _ 2(1 _ 20 _ 20 _ 20 _ 20 20 _
�renae d Camb AuOitor Caunry Date (monfi. daY. Y��
I/ We certfy urder Ne penalry of perjury that Ne above and foregang infwmation is We end cortea and that Ne applicant is a resident of IfMiana and
owner / contradjuyq of Ne afoiementiw�ed pro�n date appl'rcation is filed.
aumoivea Dy d�M exewcee
s of authae:d person (num
sLee4 �: state, and
sneet �: sfate. aiW LP mde)
7