HomeMy WebLinkAboutMortgage_Wildt"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
_ FOR DEDUCTION FROM ASSESSED VALUATION
� Sfata Fwm a3709 (R71 / 6-09)
S,.,. � Prnsvibed by De7a�M of Local Gwemment Funnce �
INSTRUCTIONS:
To be lled in person w by mail wiN the CountyAUdito! or Counry Recorder o/ the county wheie the property is located.
FiHrg Dates: 7) Real Properry: Must file dudng fhe yrear hr which the deduction is sought.
2) Abbde / Manufedured Homes not assessed as Real Property: Must file dunrrg the twelve (72) months
`'6etore March 31 of each year the deduction rs sought.
See reverse �pe qualifications. /� _
P�Y %S
erarl
H nama m �emfd is 6fterent Nan Nat of aGP��t ind'xate Delrnr.
Nartre ot mxtgagea a mnVaU seller
ACdreu N mMga9� or mntrad seAet (number and sveeG �Y• smte. aM
Nama M assignee or dhu awner w halder of mort9age
AdGrew o1 atignee (numDB/ end StreeL my. sbte, aM ZIP tode)
dirent own 7�7enY in anY oNer
InOiana?
❑ Yes
Dedumon apprwed in tlre amoum oE
tt yes, what muntyt
No
20 _ I zo x
synanae w camb nuanw
1! We ceNfy ufWer the penalry of perjury that the :
owner I mntract buyer of the afofementioned prop
� resid� �� d ap imnt n
�/ �
Person auUU�etl GY dW1' exewietl
Addreu of auCWttred persm (num
anC
Counry rt641itpd'
C�ecorder
_ w�— — ^ Recad numbel
�I C% C
tlness unpal0 az W Mongage / Con� i�Webtetlnass unpaid as d Is Ne eppAtant iha sde
date af eGP�� iegal or epuilaWa owreR
� ❑ Yes ❑ No
If wmed wkh wrm��e ottwJ ihan sPa+�. udkate wtth whom
is C�e proprlty in QuesOOn: MnueOy AsMxk
❑ Real FlopeM ❑ /vmua�N Assessed
i�i�181 T81919 �LSIf Wi7 f�25 I�16 dC�UCbM �BGII IG�UPSIGd CII pOpGf�}'
-- — -� rorcurtencrra/+ n .,__ n ..
.� �,�•� np ;� � �
,.._,..,.._--i � 83,4 50. G° � _ zo
��jp,l\ Q./Y1C.)Ct.t.Gfl oa� �,�w,. ear. r�A
_._ ....ry�ing mtortnaUOn is We and cortect and that Ne applipnt is a resident of IrWiara arW
on date application is filed.
and LP
antl sbeet �: StaM. aM Z!P oode)
Date (rtpnN, tla1: Y��