HomeMy WebLinkAboutMortgage_Harpenaw"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
Slata Fotm C3709 (R71 / 6-09)
�' y,. Presmbed Ey DeGa�N o1 Loml Govemment Fuance
INSTRUCTIONS:
To be lled in person or by mail vnth the CounryAUditw or Counry Recorder o/ the counry where the property is located.
Filirg Dafes: i) Real Property: Must file dunng fhe year /or which the deduction is sought.
2) Mo6ile / Manulacfured Homes rwt assessed as Real PrupeRy Mus! fiie dunng the twelve (12) months
before Mamh 31 of each year the deduclion is sought.
See reverse side (or additionaf insVUClions and qualificatans.
�. MP�nt (owi�D� mntraU bN'ar - see resLrliwcs m reverse side) i I
r L,rm ��crioc-v a - y�
0.�xsed ra4re drral praperty as d Mor�qage/ Cont
Maidi 1, asm¢year MarCh 1.Wrtenf
� `
�i f10. W�13� 6 �16 � �12f BIHf2 5�12IB O� Il1iPRSl�
If name m remd a diRe2ni Nan Nat W a0P��4 �inte Gebw
Name of rtan9a9ea a mnaact seAer
ncaress m �rotgayec «mno-aa seo
(numear ara sueet a+Y• srare.
uoes epq�nt v.m praperty m any omer
munry in Indiare?
❑ Yes ❑ No
�^� 6 20�9
Counry Auditw
. � 19- E�3 �' _ _ _.__8
indehtedn¢s unpaid az of Mortgage / Con7aG'vMebteAness unpaitl as d Is Ne eppfimnt Ne sok
r t date of appGrationG le9al w equilade wm�/
� ❑ Yes Q No
If awned with someorre other Nan spouse. ind'xste wvh wtwm
�S I�18 G��m/ 111 Q11CSfIW1: /Nf11130'f /�55255Cd
❑ Real Pmperty ❑ Armually PssesSed
blodle Fbrt�e fIC 61.7-i
,,/v �/`�.7�
streeL �: sbb. eM LP mde)
_ _ .. _. "- _ -- . "_ _ _ �
DI'�11'CI' 1�'D...SXti.11.{.......
CA1'Cl \`�. ... ��.,........
�y4�►8`� �
: Nis am�aw� eee� rey�ested «, p�openy
'a�rtentyea/? ❑ Yes ❑
2� _ 20 20 _ 2� _ 20 _ 20 _ 20
Sig�nrte W Co�mryAUdrtw Caunry ' Date (rtrmth, daY•Y��
I I We certfy urWer the penalry of perjury that Ihe above arW foregoing infomialion is We and mrteU and Nat the applirant is a resident of IfWWiana a�
r I contracl buyer of the aforeme�rtioned property on date appiintion is filed.
Sig (pwnefs f�nHrrle) .. Date ( 1 I� �/' IY
.iJ / I\tl ... .n., . ,. .,
rcant (hyyr�ber antl sLeef, ]ty, state.
[�
y
luly executed PoMSr of Auvney or by IC t
person (number aM sveet �: sbte. an
illlMlil. dd)%�Ba�%