HomeMy WebLinkAboutMortgage_Wernz^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Year
__ ,= FOR DEDUCTION FROM ASSESSED VALUATION
• SU[a Fortn C3709 (R71 / 6-09)
�' ,.,� 1 Presaibad by DepartmeM ol Loral GovemmeM Firence
File
�STRUCTIONS:
k 6e filed in person a by mail wiN Ure CountyAuditw or Counry Recorder o/ the counry where the property is located. F� fl� '
Fili Dates: 1 Real Pm e Must file dun the �
rrg ) p rty: ng year /or which Ne deduction is sought ���
2) Mo6Ae / Manufactured Homes rrot assessed as Real Property Must fi7e dunng the lwefve (72) months
beto�e March 31 of each year Ihe deduction rs sotrc�At �BS❑ �nty �
See 2verse side for addifional instruU�ns aiM qualificafions. ' "
Appficant ( ^ w. mnfracJ�buyer - see sL'ctions an mverse side)
1
�
�������
�13ith 1,aarm[ymr
If ro, what 5 his / her ezad share of interesl?
mntrarl seller
Address of mwtgagee or convad
Name of assignee or ather owner or hdd
AEC2ss of assi�ee (number aM stree4
, ay < , a3 - ao.i. �.�- D
Abrtqage / Contraa'viCebtedness unpaid a W Mongage I Contra(Y mtleMedn�s unpaitl as d h Ne appfxant e sde
Marrh 1, wrtem year Cate of ap legal w eQulfable mvmY!
� ❑ Yes ❑ No
If wrtred wiN sameone Mmr n spouse, indimte with wtrom
nt uMicate bebw Is property in Question: MnuaOy Asessed
Real Properly ❑ ArmUally Assessed
Modle Fiortie IC 61.1-i
i
� and streef, cdy, 5ata, anE ZIP mCe)
any oNer I If
Yes ❑ No
DeduGion appiwed'm 1tm amount of:
zo
s�q�i�,re a� c«mro a,a��r
�_ i �
N7iat
���. ���
: ihis tledutlion Oeen requested m P�nY
w�rent ynaR ❑ Yes ❑ No
�� � ��-5q�
� �$,GOO.`�i ?
�
1/ We certify uf Wer the penalry of pe�ury that the above aru _ _...___.._ __,...� �.... � �u era ma[ me appli�ant is a resident of IrWiana and
owner / mntrad buyer of the a(oremen0oned property on date application is filed.
IneMe (ox�elslu0�e) Date (morVh, daY.Yea�
retidem
m Ey
Pdtlress of autha'¢N person (num0cr aM sbce; dry. stata, and ZIP catle)
Dale (rrronN. tlaY. Ye�