HomeMy WebLinkAboutMortgage_Hicks""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n 7 hi Year ij/
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� FOR DEDUCTION FROM ASSESSED VALUATION � �
� Sfate Fomt 03709 (Rtl / 609)
�' f Presriibed Ey DepaNneN af Laml Govemrtrent Fuunce
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wsrRUCnoNS:
Form Aed wtth:
To be filed in person o� by mail with fhe CAUnlyAuditw or Counry RecnNer of the county where fhe property is located.
Fifirg Dafes: 1) Real PivpeRy: Musf file dunrg Ne year for which the deduction is soughL �� �., �/.1�DUnty Auditor
2) Mo6ile / Manufacfured Homes irot assessed as Real Property: Must file dunng the hreNe (72) months C /
befoleMarch3loleachyearthedeductionissayht GIBSQNC U�!� A���O�ef
See reverse side 7of adtlifiona/ instrucGOns end aualifications. _ ! � .
�
wd vdue d� ptoperty as of
1, amnl year
If ra. what a his / her eYatl share of intemst?
It rwne m �ecord is drtferent Uan that of aPpOpn; uWicate Eebw
mongagee « conuacc
sbeet �Y..stam.
Name al assignee or oihu awner or hdder of morigage
(numDer aM shee4 �: slete. antl ZIP cotle)
Dces epplinnt am pmperty in any oNer
muntyinlMana7 � ..
zo � zo _ � zo
i I We certify uhder Ne penal'y of perjury Nat the
owner I contract buyer of ihe afwemeMioned pro��
authorrzetl by dWy ezeartEd Power ol Attaney w by
Pddress of auNO�"ved person (numDeraM stree4 u+Y. ��.
-O -l��-aoI.B�B-oa `�`°,�
indehtedness unpaid as o( Mortgage I Con7ac[ mdebtedness unpaid as of
� O Eate of eppG�ation
H awned wiN sommne othar tlwn spouu. iMkata with �
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antl LP ootle)
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Is Ne applirant Ne sole
legal w epuitaWe ox�nM
❑ Yes ❑ No
h the V�PenY in 9uesUm: MnuaOy Asses.ud
❑ rteai a�oxnr ❑ a,m,�ny wss�ed
Drawer NO..�.1.
Card NO. .....,�R,33
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Caunry
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❑ Yes ❑ No
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infortnalion is W e and cortect and that the applicant is a resident of Irdiana aM
ion is filed.
Da�e (month. daY. Y��
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