HomeMy WebLinkAboutMortgage_Vela^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year �
.,.__ .
_ FOR DEDUCTION FROM ASSESSED VALUATION
Siate Fortn A3709 (R11 / 6O9)
S 1 PresoiCetl q OePan�rd of Laml Grnemment Frexe
INS7RUCT10NS: �n�icd
To be filed in perswr w by maii wiM the CounryAuditor or Counry Recorder of the county where the pioperty is located. JUL � y / � ���
Filirg Dates: 7) Real Property Must file dunng Me year Por which Ne deduction is soughG '�K� �
2J Mo6�le / Manu(actured Homes rwt assessed as Real Prtiperty Must file dunrn� Me IweAre (12) monfhs �Ll �unry Auditnr .
6etore March 37 o/each year the deducfion is sought C.�. ounty Recorder
Sae reverse side !or additional insLUCLOns and qualifications.
npp(xant( �or buye�-s mreverseside)
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TaAng Ois � Key numCer! legal desaiplion RetoN wmEer Page number
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Assessed vehie d re� proprity a of Mortgage / Cont
March i. ppmrrt year Martl� 1. atRnl
�
If ro. whal a his I her esatl shara of intemt?
If name m remrd is d�RUent ihan that of aPP��t �dicate Dekv`
r7ame oi �wrtyayee or conuaa sener
Address ot nprtgagee «contraa sW
Name of assimiee or ahn ovmer w h
morigage
alE
naaress ot asvgnee (numoer aiw sueet ary, srare, ana tir caoe)
Oces eppl" oxn property in any oNM If yes. riiat munt�t
caunp in l g�? r� Yes _
. ❑ No _ ,
20 I 20 I 20
- V
UnpaiE at of Morigaga / Cmtrarl
date of sPP��
If o�vned with mrtieone other'
0
s�y
n of Is C�e appfirant Ne sole
legal w equitade avreR
❑ Yes ❑ No
spouse. inQirafe �vM whom
is Ihe P�PeM in question: MnuaDy hssesud
� � a�ocenY ❑ /w,uaq' assessed
�
Dra�� er NO..•..� � �....
, .... �
��,��.io. �.�� a5�y � o No
c, ..........�....:..... —
`�3 �. Co�. ��lo3,app,pDj
2o I 2o I zo 1 zo
1/ We ceNfy under the penalry of periury that the above arW foregoing infortnation is We and correct and that Ne applicant is a resident of Indiana and
amer I contracl huyer of the aforementioned property on date application is filetl.
�n�pxr(PwnerY Nf{.�me) � � Date (nwtth. daY. )rea�
FWI rrsiEent a0df¢S W appfic�l (rwmDer antl stree( tlry, stafe, an
x/S��ln�;(Jn�.Jbrp�k l�r-. h�ri�c �a
Pelson auNO�¢e0 Oy EWy ezecutetl Power of At[omey rn by IC 61.
Pdtlress of authafved person (numbere� street, rily, sfafe, aM 2
Dace (monN. daY. N��