HomeMy WebLinkAboutMortgage_Parker (5)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou wnsh Ye
� FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm d3709 (R77 / 6-09)
�' Resmbed Ey DepartrtieN af Local GovemmeN Firerc< ' h
fR
wsrRUCnoNS:
To 6e filed in person w by mail with Ihe CounryAudifor or County Recorder of the county where the pioperry is located. `-F-����fl� '�
Filirg Dates: i) Real Pmperry: Must file dunrn� the yrear fir which the deduction is soughG J' ,�d��
2) Mo6de /ManuFactured Homes rat assessed as Real Property Musf file dunng the tweNe (f 2J months ��
6efo2 March 31 of eech year the deduction is sotyht GIBS N�NbUn1y1�C'�'dr
See 2verse side for additronal inshuctions and qualifications. __ _
nt wnerormn(��atl6vyu'�25�r�s-onie(W�eiiie)
A5365� Vdhl¢ O( R21 poperty az of Mortg age/ Conl
Marti� 1. anart year Merch t,i rtert
\� t �
If no. whal is IuSI her exatl sltare Of intexV?
tt name m remd's dmuenf uan that oi app0cant, uWicate Cebw
rlame m rtiorcqayee or mnrra� seon �} ^ �
Y
L_.
Adtl�ess of mortga9ee or wntrad srder (nvnbeiand stree; rny. s
Nama of assignea w aMe1 awner or holder af rtortgage
Address ot assignee (number aM stree; itiy, stere, end Z/P cade)
Ooes eppli�ant ovm pmperty in any oNer
counry m InEiana?
❑ Yes
amount
[L�ii7
..
u yes. what camty�
COU
20 20
1/ We cert'rfy u�er the penalry ot perjury that Ne above arW toregoing i
owner! contrad buyer of the aforementioned properry on date applicati�
y�elawxr57y,Orame) A �\ \ _
state,
o(AttomeY w by IC 61.b12-0]
AAtl�ss of autha'¢etl persan (numbu arnd sbee; dry, state, aM
unpaid as o( Mortgage I Cantract uWehtedn¢s unpaid az d Is the eppGmnt Me sole
date of appGqiion legai w c�uitaEle ame(.�
— ❑ Yes ❑ No
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� ?� I,'� 50• °�
� ao09 -35 3`f
ea on p(operty
'es ❑ No
Z(1 _
1
of IrWiana aM