HomeMy WebLinkAboutMortgage_Johnson (15)'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun shi Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
� - Stata Fam d3709 (R71 / 6-09)
S,�,. Pfesoibed �y DepartmerR W Laal GoremnrerC France
A��i a�c
INSTRUCTIONS: F�m� .
To 6e fi(ed in person or by mail wiN the CounryAuditor or Counry Rexrde� of the counry whefe the poperty is focated.
Fi/irig Dates: 7) Real Pmperty: Must file dunng the year lor which the deductlon is soughG � un Auditor
2) Mob�7e /ManufaUUred Homes rat assessed es Real Properry: Must h7e dunng the twelve (12) monfhs �
6e(ore Maich 31 o/each year Ne deduction is soughG Q�BSO �der
See reverse side foraddifional insLuctbns andqualficafions. ITQR
MW��t( ror,corrtfa�hyrer-saelasyiNqf(�mreversesila) // �
n�,ed � d r� c�ce*,y as o�
Ma�rh 1, Pmnt year
I( M. W�Idf 6 i6 / flPl BYdQ 5�12IB Oi YIiCfCSi%
0
1f name m mmN 5 QRerent than ihat af app0�ant. 6�Oipte Celmr.
Name at rtartgagee «mntraa s[
Pddrev d mortgagee v mntracl
oxner w hoNer of rmtgaga
of assiyiee (number and sCee; cdy, stete. and LP
Dces appfimnt own property in any other
counry in Ind'ana? ❑ Yes �
DeducGOn approveC u� ihe amounl oE
20 _ 20 _
Sigrature otCamhnWnor
� i. � . � . a � i .r � �1 � c .s� � � � �
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riry. smm. ard LP cade)
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7
yes, wnat munyt I wnat �anr
COUNTYAUDROR
� — I 20 _�
� 1/ We cert'rfy under Ne penalry of perjury that the above and foregoing intw
owner I contract buyer of the aforementioned property on date appiicatlon �
� Sgna4
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`' FW res
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1_ J�
Pe�sm
f 4�: state. aM Z1P cade)
r;��ce�� /.✓ �17� � d
lUf�may or by IC 61.1-12-0.7
autl�or¢ed persan (numberalE sbeet, cdy, slata.
Rem'd mimb�
as d� u,e eoo�+� are sad
I¢gal or eputtade oM+�en
❑ Yes ❑ No
wiN whom
�5 p12 �IO�C(L� Ifl QUESb011: /YIIIUd� i155255Ed
❑ Real Rovertv ❑ ?imuaM 0.ssessed
Has Iha deductim
tw artem YPa!'
_' ' _
Dra�ver NO...°�ll% �• • • • • • •
Card NO. ....cJ�. �• �.....
y�, ��� "V���
�LL
Date (morrth. EaY•
m prapelty
❑ No
0_
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