HomeMy WebLinkAboutMortgage_Mathis"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun'
__ .; FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn d3709 (R11 / 6-09)
�' w. � Presoibed by DeparimeN of Loral Govemmerrt Frarce
INSTRUCTIONS:
To be filed in person a by mail with tha CounlyAudito( w Counry Recorder o� the county where the property is located.
Filing Dates: i) Real Property: Must file durirg the year (o� which tha deduclion is soughG
2) Afobde / Manufac2md Homes rat assessed es Real Properly Must file dunng the IweNe (12J months
before Marcfr 37 of each year the deduction is sought.
See reversq side fur addRional insWCtions and qualificafions.
�
� 6o�r(j��uditor
❑ Caunry Reoorder
�AppSCa^7,(el^ieroyconhacbuye�-seere�w'rt�gocqreve.rse.vd@) iilB$� ~
ITp striG KeYnu Ifer/IegaldesaiPti
AscsseO rWue Ureal praprlty as d 'h1or(pape/ Cant
Ma�di 1. arm� year Mart3� �, wrtenl
If ro, whal is his / tcer esaa share Ot interrst?
tl nartie m remN's E'Aferent Nan tlWt of app�tant. "uWiCate bebvr.
Name ot mrtgapee or mnvacl seller
Addtess or nqet�agce «contract sen
Does appii�nt wm prope�ty in any oNer
ca,Hr �� ��aia�,a? ❑ res
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sfale, end ZIP code)
I( yes, what count�?
I No
,;��
u
N COUI
Recard number
-oa� 6� o
I Can� uMebteEness unpaid az d I
titable o�meP
Ye5 ❑ No
someone oC�er tnan spouse, marcate wm wlwrn
Is C�e P�PenY in Ouestion: MrwaM Assessetl
❑ Real Roperry ❑ Armually Assessed
WtmtTe�dngD'sVK11 /� ��� d� e+H
� �35 �' 7n
)UNTY AUOROR
��' m ��a �D� �`a� -
Z� c����+ �� � � - —
ISig�nne ot Camb Aueitnr I Caunry I Date (rmvh, daY. Y��)
1/ We cerbfy unAU Ne penalty oi peryury that Ne above and (oregoing infomiation is W e and corteci arM Nat Me applipnt is a resident of Indiana and
owner I mntrad buyer of the aforem 'oned roperty on date applicatlon is filed.
� SignaN (owne/s7Wllre ) Date (monfh, day, yaa�J
✓.
F nt � of a (nu r ntl stree4 dry, sbte, and Z!P mtle)/j�
�` ,_5�/� /!� 0 : Sf /� �rlC�r . -�il • �'%6 %D
Pdtlr� af aNhar'¢ed
rieY or by IC G7.142-07
cdy, stafi. aM Z!P code)
Date (monfh, Oay,
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