HomeMy WebLinkAboutMortgage_Johnson^�� STATEMENT OF MORTGAGE OR CONTRACT INDEB
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
� � State Fortn d3709 (R71 / 6-09) � � �
� f Prnsoibetl by DepaRmeM o( Loral Govemment Fnance
�sTRUCnoNS:
To 6e Red in person w by mail witA the CountyAuditor or Counry Recorder of thq,.��
Filirg Dates: i) Real Property: Musf file dun�q fhe year for which the deduction'1! sdug t.
2) Mobr7e / Manufactured Homes rrot assessed as Real Prs�peerty M�s{�fii�
6efore March 31 0/ eacA year the deduction is sought.
See �everse side fa adUitional instrucfnons and qualifications.
TEDNESS Coun Township Year
� y File Mark
Fwm t�e0 wiN:
ry is located.
� CountyAuditnr
(12) months
County Recorder
r �.. ,..w ._,_ � G--�l a- I 8- 1 D aocY�, 7l� -b ---- - a[DId "�l�N
ed rakre dreal popatY a. d �R9a8e / a indebte�ness unpaid as d Morigage / CanttaU iMebtedn�s unPaiE as d Is Ne aPG�ica�t the sde
1. acm1R Y� Mard� t, a er ��I date� Plxatmn � O e O
Yes No
tl no, wha� Is �a ! trer exaa snare a intemsr!
If �me on remrd's NtFerent ttan Nal 01 app&ab, h�tivafc
o� m�cgavee a mntraa uua
cdy, slate, aM
_ _—
� `���.@�
`�1�.........
Dra���er NO.......
� Card 10. ...... �.��......
20 � � � p
I/ We certify ufWer the denalry ot perju� that Ne aGOVe and
owner I contrac[ buyer of the aforemen4oned property on da
Address
S/3
Tarirc� Districl?
COUNTYAUDROR
4 appGCant (�m�Dne� antl streef, tiry, state, arM LP mtle)
J wtii �%Lc �. c_e.. �M I.. Ls �
futy executed Powerof Attomey r by IC 61.742-0J
person (numbelantl sbeet �Y. slate. antl ZIP rotle)
sPo�se. iMkate wM wham
Is tl�e P�GertY in Guestim: MnuaDY AssesseE
❑ Real ProPertY Q MnuaI�Y.Psessed . . .
Has this dedu�m�, Eee� �9�esteE on property
� ��� � n Yes ❑ No
20 _ 20 _ 20 _ 20
— ��ry (�- Date(mmM. Y.Y�a_CJI l
���` �
ig infortnation is true and correct and �hat the applirant is a resident of Indiana aM
ation is filed.
Date (rtmfi. daY. Y��)
Date (monN,