HomeMy WebLinkAboutMortgage_Hyneman (4)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
,_ _ FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fortn d3709 (R11 I 6-09)
� y�. j Presfiibed by DePaM�M of LoCel GovemmeM Fuance
1�8
INSTRUCTIONS:
To be filed in person w by mail with the CounryAUditor os Counry RecoNer of the county where the properry is bca . F �� �
Fd'ug Dates: 1) Real Property: Must file durirg the year for whirh Ihe deUUCfion is soughL Cpun Auditor
2) Mobde / ManulaUuied Homes not assessed as Real Property: Must h7e dunng Ne M1veHe (12) monfhs �,.�� ry76
before March 37 0! each yenr Ne deduction is swght. AY 4�.�..•r� •e�de�
See 2verse side for additiunal inst/uctbns aM qualifications.
ADD�� ( ormvraa b�yer y5qe m reverse sde)
�����ffi�
Ma�rli 1, amnt year
I
tt ro, what Is his I her e�tl share ot Interx
tt nane m remr0 b Oirte�ent lhan Wt of a�
Name W rtrxtgagee w mntraU seller
Md� of rt�or[gagee or mntract u0u (n�
r�„a � �� «ang �,e� a naa«
Pd��ess of astigtiee (num6ar eM street a
Does applimnt own property in eny othn
f�i
cq�kr/Iegaltlesai0�u+ �$Gi11n� P�4'fiuinbPi
- aM�-qyo _ oa-oo�. 3��-oaa' aoQ .�a5�
Merd� 7 armnl year htMness urryaid az of tlM QiBagePl�Cm�'vNebteA�wss im7aitl as of � t� �� owne/?
❑ Yes ❑ No
If ownad with someone oNer than spouse. ind�te with whom
lmnt trMirate Eelmr. Is Ne D�P�Y in Vuestlm: MiwaM Pssessed
❑ Re21 ProPenY ❑ %�^�' �
�
smm. aM ZIP cnda)
Dra�r�er NO..a��.........
state. and LP cada) j� � —
1
CardNO . .....................
tl Yes. what muntyt Nmat Tadi ��O OM �O .. . �y
I No � �..v. � ' . � No
COUNTYAUDROR
Datiuction apprrned in tlia amount of:
20 _ 20 _ 20 20 _ 20 20 _ 20 _
Sigfawre W Camb nwftor Caunry Date (monN, dar.lBaA
1 I We certify uMer tha penalry of perjury that the above and faregoing infortnalion is We and cortect arW that the applirant is a resident of IMiaru aM
owner I conhact buyer o( the aforementioned D�PertY on date apPlicalion is filed.
Sipnayra (o !�m reme) Data (ncntl�. OaY. Yea�
/
F�ID msitlent atltlr¢ss d aCP��t 1nu � artl L�Y slate, arN P e) !// / O
S .3 0 � �LvYcCe��c. /V �� ��
Pr�son autlo�sed b/ dWy e�eatetl Pwer a(Attvney or by IC 61.7-12-0.7 Date (morNh. daY.Y��
Pddrest ot aWmi'ssetl person (num6e� aM sbeeG dry, slate, and LP tode) .