HomeMy WebLinkAboutMortgage_Meier (4)^'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
__ . FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Fortn C3709 (R71 / 6-09)
�' ,.,. � Presaibee q� oepanmem m lmal Govemrtient Fuiance
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INSTRUCTIONS: ,i� �n
To 6e filed in person w by mad with the CounryAuditor or Counry Recorder o/ the counry where the pmperty is located. �y O� Z �� �
Fi7ing Dates: 7) Real Property: Must file dunrg the year Por which the deducLOn is sought. �� Counry Aud"ROr
2J MobAe /Manufadumd Homes rrof assessed as Real Pruperty MuV h7e dwing tlie tweNe (12J months
be)ore March 31 o/earh year the deduction 's sougAt. �Y R��
See reverse side 7or additionaf insVUCGOns and qualifications. C,IRSnu nn� �.��.. ..._._
AQestt�C value � mal p�operty a
Alarch 1, a+mv year
rc no. wha� !s his � her e�me sha�e
tt rwne m txaN s SRtemnt tl�an
rlame or rtiorq7aqee «mnaae seucr
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MoRgape/COntract4
Merd� 1. a�rtem ymr
Address d mort�agee w mntract seder (nun�b6 ary"sO
1
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Name of asi�ee n Wrer owner w hdder of nqrtgaga
ACOrea of asvcpue (mmiber aN saeet �: sbh, en0
Does epplipnt own pOpCty in erry ofhu
muMy in Indana?
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Dra���er \'O. �Q��........
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! ' FWI iesMent add�s
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Pe+son autloraetl Ey
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urryaid az W Mortgage I Contafl'vWebtednese unPaitl as d Lv Ne aPP�t the sda
Eate of aPP�� � a MNm� �
_'s9 �� n Y� n No
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cdy, 9a�, aM LP code)
ootle)
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5, whal muni�?
COUNTY
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� P�G�Y in OuesDm: MnueOy Assessed
rteal Property ❑ nrm�any wssessea
abaie rame nc s
Has 6iis tleEUi]ion Oeen requested m property
tor wrtmt Yea(? ❑ Yes ❑ 1
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20
� and toregoing mtamatlm is true and cortea and that the applirant is a resideM of IMiana and
_, on date applica0on is filed.
Date (rt�lh. daY. W�
sbee4 aN. srate� and ZfP cade)
_ Ph Idl'n �„-i-�1 �76 Zo
ACdrass af autlmrrsed permn (numbera�M sbeef, dry, sbte. arM Z!P cotla)
(rtionfh. daY. ri'e�
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