HomeMy WebLinkAboutMortgage_Murphy"'3 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun hip ean
_, • FOR DEDUCTION FROM ASSESSED VALUATION �
• State Form d3709 (R11 / 6a9)
�,�,� 1 Presaibed by �epartmeM ot Loral Govemment France
�srRUCnoNS: F��f�ff�1 � ZD�Z
To 6e lled in erson w b mail wiN the Coun Auditor or Coun Recorder of the coun where the ro F� �� �� ^""�
P Y N N �Y P PartYislocated. j,fYb�+.� ..-�
Fil"mg Dates: 1) Real Pmperty: Must file dunng the yea� for which Ne deductlon is sought. � � Coun ,4uditor
2) Mobile / Manufactured Homes not assessed as Real Pmperty Must fife dunng the M1velve (72) months n ry�� V
� 6efo�e Ma�ch 31 ofeach year ihe deduction is sought. IBS�'! C�01":��efOR
See reverse side 7or addiUonal instructions and qualfirations.
AppGcant( rormntraCqeb+er„seerestrclbpS�n2versesidg{ n , l) /
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If no, what a his! her exart share of intrlesl'�
If riame on mmN a diflerent than Mat o( appGran4
Name of mortgagee or mntract
nqrtgagee «contraG se4er
othu owner or hdder of mori�age
�-G _���" OD� �/ °' '�G! U �� / �J
:/ Contract inde6tetlnrss unpaid az ot Morigage I ContraG uNebtedriess unpaid as M Lv t�e appGcant Ne sde
curtent year date of app`�/ leqal w equBade axndl
05 /(p� • �7 ❑ Yes ❑ No
1/ owned wiM someane other Ihan spouse, irMkate wiN whom
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AilCress of assig�cee (nurt�ber aM stree( cdy, sbte, an0 ZIP coCe)
Dce5 aPWicant ovm property in any oNer
munty in IMiana? i-'1 .,_'
20
SigfaMe o(
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at.
p
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' What Tadng Dbbitt7
COUNTYAUDROR
20 20
Caunry
�Is P�o7enY in VueSGm: NmuaM Auessed
Real ProPeKY ❑ !��Y �
aoiv
; llra�ver NO ...................
5��/ 3
cz��a �o . .....................
= � �a, ��s.3�
20 20
Date (mmth. daY• Y��
I I We certify uMer the penalry of perjury that the above aM foregoing infmmalim is true and cortect arW Nat the appiinnt is a resident of I�iana aM
owner / mntrad buyer of the aforemenUoned property on daffi ap�catlon is filed.
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F�A resident add�ss
l� _" i��
G� /��1���t �� 1
f aower orat«ner w M�c u7.1-12-0.7
Mtlress at a Wwr'rzed persan (numberaM sbeef, �y, sbte,
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