HomeMy WebLinkAboutMortgage_Nelson (7)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun rownship Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 03709 (R71 / 6-09)
�' ,,,. Presaibed by DepartrtcM of faW Govemment Finaice
INSTRUCTIONS:
Fam filed wiN:
To 6e filed in person a by maii wiN the County Auditor or Counry RecoNer o( Ne county where the property is locate�(_j � 9/ �� �
Frtirg Dates: i) Real Property: Musf file dunng the year (or which Ihe deduclion is sought � County Auditor
2) Mo6i7e / Manufactured Homes not assessed as Real Property Must fiie dunng Me KveHe (12) months
be/ore March 31 of each year Me deducfion is sought. ❑ Cou^ry Reoordu
See reverse side !or adUi[ional inslrticUons and qualificafbns. �`(�
Aoofxant (a�merormnfraC buvu - see resNKlions m reverse sidel �ITOR
Ta ' istriC a v KeY nxnber / legal dawiP�n
-la-o�- /03-00�.? v,8-o �
Assessed rahre d rnal ptoperty as d Mortgage/ Contract inde6tedness unpaid az ot Mw(qage / Carttr
A1�M 1. anmt yrar Mamh 7. artent year date af aPpGOtia
DOD
If Ib. Wh9I IS hiSl hC! Cf3f15h8IB 0( YI}PJPSii If OWfIBd `MIh SORIC0112 Oth
tt name m remrE s CilFe�mt than ihat af aGP��t trMirate below.
Name of mwtgagee «mno-act seNer � �
af assgnee or othel wmu or hdder of rtortgaga
AdCress of assignce (number and atreeG �#l: 5ste,
Dces a�imnt Ovm property
[wnty m Ind'ana? r
�
� ��
1/ We certify urWer N
� " owner I contraa
� \ �///��/iinn�( D ,
AOdress
of
c'ry, sb�, and LP coda)
��-�-t �� �.
munl/� WIretT3�dngD"atnc[?
� , �_ , zo
y of perjury that tgE above aM foregoing iMOrtnation is we ar
aforemendoned P�PQnY on data appliration is filed.
em �et «4: trate� aie
q� eWr �ewced aowes wammer or M�c si.l-lz-0.1
ed person (number amd street tiry, state, aM LP code)
wmCu
as of I Is ihe epp4an[ the sole
�gal w eWira6le o�nx(.�
❑ Yes ❑ No
sDOUSe. iMimte with whom
Is tl�e propP,rcy in QuesGOn: MnuaAy Assessed
❑ Real Roperty Q Mnually Assessed
Has M's de0ueion Daen re9uesied m v�Y
farmmrtYeaR _ ❑ Ye5 _
❑_ No
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