HomeMy WebLinkAboutMortgage_Northenor.t--"-'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n T! hi vear
f,, . � FOR DEDUCTION FROM ASSESSED VALUATION I
Sta1e Fwm d3709 (R8 / 2�07)
���, Aesaibetl by Oepanmenl of Local Govemment Finance MA 1 O
1
File Mark
INSTRUCTIONS: �/
To be filed in person or by mail wdh the CountyAuditor of the county where fhe property is located. � �p ±i ��s-y
Filing Dates: 7) Real Property: Dunng the 12 months be(ae June 11 0( fhe year the deducG'on is to be eflec6ve. (/ (/�
2) Mobile Homes assessed under IC 6-7.7-7: Behveen January 15 and March 2 o/the year the ded�ibS4itio(l��E�XvAUDITOR
See reverse side !or addilional insbuctions arnl quali�tations. .
or mnLad
onieverse
Tab isUiti . Key number / legal desaiption Record number Paga number
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Assessed ralue of mal poperty as of March 1, uurenl yaar Mortgage / Contra�i irWebtedness unpaid as M March 1, Is Ihe app6cant Ihe sde legal a equitade wmeY?
wnent year ^ �
�% ❑ Yes ❑ No
, what is his I her eud share of interesl? If owned wilh someone dher Ihan spouse, indirate wi�h whom.
If name on record is different Ihan Uat ol applicant, indiple 6elow: Is the property in question: '
� Real Pmperty ❑ Mobile Hane (IC E7.1-7)
Name of morlgagee ar conVact seller
Address of mortgagee or mniract seller (numberantl sMeef, o!j( sfa(e. aM ZlPcade)
Nartre of asv9nee w dher oxner w hdtler of mortgage
Does appliwnt o.m property in any dher
caunry in Ind'ana?
❑Yes ❑ No
Oeduclion approved in lhe amount of:
20 20 _
SignaWreofCaunryAudibr � /
�e
I/ We cer � under the penalry of
Indiana and owner of ihe aforeme
,�r�"'�C��1J� ��/CwL°
If yes, whet caunry?
20
VJhat raxir
COUNTYAUDROR
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20 � 20 _
(manfh. tleY Y�A
Nat the above and fwegoing infortnation is true and mrtect and ihat tlte applicanis was I were a resident of
property on March 1, 20 `
Date (manfh. daY.Y��
j resident atldress of applicant (numberand slreeL cdy. ale. and ZIP tnde) T
� I Z�� '� C/Gi^� St. ,�/j��>GtT0�7�L� L/�7Iv%O
Person auihaized by duly exealed Power oflU ey or by IC 61.142-.07
Address of aWlwaed person (numberaM s4eel. dty. stafe.