HomeMy WebLinkAboutMortgage_Green (6)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ = FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 03709 (R11 / 6-09)
,' ,w � P��� bY DeParcment of Local Govemmenl Fnance
� � e Mark
�NSTRUCTIONS:
To be filed in person a by mail with the CounryAuditor w Counry Recorder o! the county where the property is focat F �
Fd"mg Dates: 1� Real Pmperty: Must fde durrrg the year (or which Ihe deduclion is soughL Coun dimr
2) Mobde / Manufactured Homes not assessed as Real Property: Must file dunng the lweNe (72) monfhs
6etae March 37 of each year the deduction a so�yht F B��f'iawly Recorder
LUIC
See 2verse side !or addi6onal instructions aM qualilcations. r, �._ _
Tab ' trid Key rwmber / legal tlesaiption
� - -aD3-ooa. 3�
Assessetl rehie d real YoO�Y as at Mortgage / Contract'viCebceCriess unPaid as of Mor
ress
Marrh 1, qr�ali ypar Mard� 1, Wrten� yeer dat[
If no. what is ha / tcer euct share ot interest? If owned wiTh
If �wne on �ecdd's diRerent ihan �hat ot applicant uiEim[e bebw.
Nartre ot mortgagee « mntrad seUer Q�f \ n
Pddress of nvtgagee ar mntraa seUer (numbe� and shee4 cdy. sbfe. and LP code)
dhv owner w hdder ot mntgage
Does applimm o.m praperty in any oNer
munry in Intlia(u? ❑ Yes
I
Detluction apprmW "v� tlre amount of:
8te, and ZIP code)
� a�,���,�M
No
20 I 20 I 20 I 20
I/ We certify under Ne penalry of
owner ! contraa buyer of Ne afon
1 Sigriature ('wn�rY hdl reme�� 1/
x l. .
Person audq�¢ed W Eulv exewted Power of
- o d.8 � 2.0
_/ Cmbaa indebteCness impaiC a d
Whal Tanrg Datnct?
F39
Is Ihe aPP�^t the sde
legal w eQUitade rnmeR
❑ Yes ❑ No
SGW50. IfIdC210 N'Ifh wllqfl
Is Ne pmperty in QuesUm: MnuaM A�sed
.�Real Roverry ❑ aun,ua�y0.sse.csed
ao�I .
' 1 .........
_ ....
j�C�\YCI' L ....
C�i-� \O
I 20
. .. �°�?9........
� SI,G�O.°°/
0
ihat Ne a�M (oregoing infortnation is true and cortea a� Uiat the applinnt is a resident of IMiana aM
�ed pmpe date applvabon is filed.
Oate (nmth. daY. Y�h
�
eef. tiN. sfefe. aM ZIP code)
��Pi.dGt'T��1/. /�/ H767D
meY or Ey IC 61.1-12-0.7 � Da[e (rtpnN. Oay. y2a�
Pdtlress of auCrortred person (number aM stree; tlty, sbte, antl