HomeMy WebLinkAboutMortgage_Wallace (17)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun hip
_ . FOR DEDUCTION FROM ASSESSED VALUATION
:• Sta[e Fomi C3709 (R71 / 609)
�• ♦ Pfesaibed by DeDaRment of Local Gwemmerit Frunce F/+iT�Ra'l O? O � Z
�JSTRUCTIONS:
F
To 6e filed in person w 6y mail wifh the CountyAudi(or or County RecoNer of the county where the property is located. -•
Filing Dates: 1) Real Pmperty Musf Re dunrn� the year for which the rleduction is sought Coun � r
2) Mobife / Manufadured Homes not essessed as Real PropeRy Must fi7e dunng the hvelve (72) months
before Mamh 31 ofeacA yearthe deducfion is soughG GI SO �3lV9�Y �1949F�OR
See reverse side for addtional instructions aM qua/ilcatbns. _
Key rcunher
sessed rafue d real P�oPertY as d
arU 1. arrenc year
m, what's his / her esact share M intsest?
tl �wrie dl femfd 6 C'iRerenl
IJame of
Addres
irWebtedrress
sLee4 �Y. stam. ard
mortgage
(rurtn6ei and sfree[ my. sbte. antl
Oces applimm pm poperty in any aher
munry in IrWiana?
❑ Yes
�
Deductian sGW� In the amount oF.
20 _ 20 _
Sig d un ', r
I/ We certify ufWWes Ue pena t
owner I contract buyer of the afor
Siprenue � e`S 1 ame)
FuP �esitlent add2s ot�pp�can numd
If yes. whal wuntyt
COU
20 20
-cn�. a �-oa�
as af Malqage I Con7aC "uNe6teEri[
date of app&ation
Ta�dng District7
20
:-,�"'
Is Ne eppGmnl �he sde
legal w equilaWe ame(?
❑ Yes ❑ No
IS MC ProOQnY 1I1 Q11PS11p1: MN19M A52SSGd
❑ Real PmPeAY ❑ i�nnually `Asessed.. _ _
Has Nis deduction Eeen
for current year.+
20
on praprlty
❑ No
20 _
I �nry/�A� .i I � `�h � �� �O�
! l
perjury Nat ih ov and foregoing informalion is true and cortecl and that Me applinnt is a resident of Indiana and
sme`rtirned erty on date application is fileE.
Poaer of Attamey w by
entl
W auNoraed person (number eM sbee4 �#Y. �+a. aM LP mde)
�/ 7(0 7
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