HomeMy WebLinkAboutMortgage_Lecloux'°* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ip
s FOR DEDUCTION FROM ASSESSED VALUATION
:.-- �
State Fwm a3709 (R71 / 6-W)
�,,,, � PresaibeE �y DePa�M of Wral Govemmem Firence
File "
�VSTRUCTIONS:
Fortn fled witA:
k 6e filed in person or by mail wifh (he CounryAuditor or Counry Recorder of the wunry where Ihe propeRy is located.
Filirg Dates: 1) Real Pmperty: Must file dufiig Ne year for whicA the Ceduction is sought ��� � �
2) Mo6�7e / Manufectured Homes rrot assessed as Real Pmperty: Must fiie dunng the tweNe (12) months
before March 37 o(each yearthe deduction is sough[. CW�� qUDITOR
See 2verse side /or adtlifional instruUions and qualificafions.
1(owner or convaU buyer - see resbicl�en{ m revzr;e vtle) !� l� _
i Key rnimber l 1eg21 Oesviption
��-ia-��-ti
0.seae0�rnal papsty as d Mwtga9e / Contract'v
Mart3� 1, qment year MarG� t. airtent yeer
It ia. what is his / Mr exaU shara
nartre on
rvame rn mor�9a9ee «mno-au seuee
naareu w m«ryag� w mnUaa seoe�
Name af asv�ee or other awner w haltl
PAdress of assgnee (number arM sfree4
Ooes applinnt wm pfoperty in any oNer
counry in InCiana?
❑ Yes
Deauction appro+ed m the artaunt
20 _ � 2�
Sigiahrte N Camry Auditor
ca�4 mdinte bebw.
' and sbee; ciry, state. and ZfP cada
mongage
sfate, a� LP ootle)
�� �. �� ���m
I No
ry COUI
� �o
unpaid
imV� az d U Me aP�t Ne sde
�egal or epuitaNe own�+
❑ Yes ❑ No
riN someone other ttun spwae. indicate wtth�
—r —/ .Sr�m� A
�G �{-..��� �1
RE � � �'�A �
Ci�R Pm�N, �i � r� �� � A�
What Tabi
AUDROR
Counry
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�5a, 000.a�
I �_ � 03�
Date (rmntn. eay
I/ We cert'rfy under ihe penalry of perjury that the above and foregoing in(ortnalion is we and cortecl arW Nat the appluant is a resident o( IrrcJiana arM
owner I contrad buyer of Ne aforemerrtioned proDertY on date applica0on is filed.
�fawre (owneYS NO name) � Date (rmitl�. daY Yaa�)
FWI restlent addrets d apprcant (q(mDer arM street aN, s+ate. aM Z/P ootle)
a�/� � rr1a,,,00 �f ,__P u� T��
Person aWn(aed by duh/ ezewted Power W Auane-- y or byZ61.1-12-0.7
Address of auNOrrzed person (numEer an0 street. dry. sfate. antl LP mde)
oa�e Imo�an. eaY. tear�
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