HomeMy WebLinkAboutMortgage_Jenkins (4)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun hip . Y r
_. ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn A3709 (R11 / 6-09) �
,' w. Preurihed by DepartmeN o( Laml GovemmeM Firence
F�,ar16 - LUIU
wsrnucnoNS:
To be filed in person w by mail with the CounryAUditor or Counry Recorder of the counry whele the property is located. F� fl� �:
Fifing Dates: 7) Real Property: Must file during the year for which the deduction is mughG ������
2J Mo6�7e / Manufeuured Homes irot assessed as Real Property Must file d�nng the lwefve (12J months n /'untvR �
before Maich 31 0/ each year the deduction is sought G I S�YC�N 1 Y��OR
See reverse sida for adtlitional instructions and qualificafions.
Applrary.`owrieruconbae6yer'seyrasfii'D�mrewrsantda) l
� " a6 -ia-o� -3
As�ed ralue d mal qoperty as ol Mortpage 1 Contrati inde6t
March 1. anaa year Mam3� 1/.� year `.
J (
It ro. what Is h'a I her entl share ot interest?
It rwne m remtl is diRereM than Nal o( aPP�^L'mtlicate belrnr.
Name of rtprtgagee or cmtraCi se�er �
A�dress M rtartgagce ar wntract se0er 4
Name of asvgnee or oUwl owner w hdd
AOCress of assiyiee (number eM L
Does epqrcant axn yoperty in any oNer
counry in Inaaria? ❑ Yes
����;�;
��.
Reco�d numbr! Page wmOni
- 000. �`/� - o a. 8 aor O �1��3
unpaid as d Mwtgage / Con� hNebtedness �mpaitl as d Is Ne appfcanl tlx wk
date o( appficatirn legal w equitade oxneYl
❑ Yes ❑ No
If ownad vrith someone ather tlun spouse, ind'xate with wfwm
IS tlM ProDeRY in Qursoon: MmieOy As.eSSed
� Real Roperty � AMUally AssesSed ...
er m rtprtgage
tlry,stafi.anELPoode) , �
U%��
If yPS. what muntyT What Tadng
❑ No
20
�
Flaz Vi"s
for arte
zo_ � ��K�, a��y�
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I/ We certify unLer the naltfi pe ry that ihe above arW foregoing intortnalion is true and
ovmer! wntracl bu f th ntioned property on date applicalion is filed.
��� �o � i
WI resMent ad�ess W t�(�j'mber arW street �1y/,� te, and LP mde)
� 2� S._ a� ///v S-J� /ii,. ra -�o-� ZN Y7d ��
Pason au0wraed Cy duty ezewted Porer of Avort�eY w tr/ IC 67.1-12-0.7
Pdtlress oi aNhortrr� person (number and slreef. fity. state, and ZIP coda) .
Date (mvh. AaY• Y8�
Qate (rtmU4
� P�Y
❑ No
�_ `__ -- _ _ . _ ._ . . _ . . � .._�, ,. �