HomeMy WebLinkAboutMortgage_Moody"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ .� FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn C3709 (R11 / 609)
� � Presaibed by'pepartrrieM of Laml Gavemrtrent Fi(wice
� � File Mark
INSTRUCTIONS:
k 6e filed in person or 6y mail with the CountyAvd'Rw or Counry Recorder o) the county whe�a the pioperty is bcat F� �� ��
FiHrg Dafes: 7J Real Property Must file durirg the yaar fir which the deductbn is soughL ��yn�ef
2) Mo6ile /Manufedured Homes not assessed as Real Pioperty: Must file dunng Me hvefve (12) mon� t�
before March 31 o(each year the deduction isSdpht. r�'''
See reverse side 7or addiGOna/ instmctions and qualificatrons. \ � A�� � � � �„
�y
F / legal dawiption
-/a-i8-�oa-o o.
Mor(qage / Contrafs irdehtetlness unpaid as o
Mamh 7, turte�rt year
i/ ro, what Is lus i tcer elmd snare ot InteJesr.+ '
If �wrie on remd is Qifterent lhan tlu[ of aPp6rani, iMkate bebw
Name of rtnrtgagea or conttact seller � d �yA
`�-CY ✓v
Address M rrort9a9ee ar cmbact se0er (num6cieM stree; ciry, sbte, aM LP code)
Nama ot assignre w other awner or ntlaer ot mortgage
AACmss o1 ass�e (num0eiand shee( ary, sfate, e�P code�
.J C%'Ci�O`- 8
Dces applimnt ovm property in any oNer If yes, what munt�/?
munry in IrWiana? ❑ Yes ❑ No
DeduUm apWwad In Ne amount of:
20 20
Sig(anne W Cauity aiditor
�
I I We certify under the penalry
mrmer l mntrari 6uver oT Ne x
20 1 20
What Ta�dng Disvicl7
� �
i
e and foregoing infortnation is true and wrteU a�
on date application is filed. • ,
FW �si0ent5tltlress of appfcant (u(ImDerand sbee4 �: state, ane zlP m
�?/ S. STo iPinc.�7 /�i; /n/cr"jc�✓
PerSOn au0rof�d Oy dtly exewietl Powri af HttomeY � bY IC G7.1-12-0.7
AdC25s o( authomEd Oersm (number aM sbeeG dry. state, anALP mtle)
f�
spouu,
Yes Ll No
perty in quesUOn: Mnualty Assessed
ProPeKY QArmuallyAsse55ed
Mobile Fbrtie (IC 6
� �31
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