HomeMy WebLinkAboutMortgage_Zelko^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN�SS,, � oun To ship Year
; FOR DEDUCTION FROM ASSESSED VALUATION g
-' State Fwm C3709 (R71 / 6-09) .
1 Presaibed br �Pa�� d tnd corenvnent Fria(ce
ile Mark
INSTRUCTIONS:
To be (led in F� �� �: '
person w by mail with the County Auditor or Counry Recorder ot the county where the piopertyis�bG�te�d. � -o,
Fi7'mg Da[es: 1) Real Pmperty.' Must file during Ne }rear for which the d�Uuction is soughG %� �� �j � � Counry Auditor
2J 6efo/ee March 37 o/each year tAe deduction is soughPi6perty: Must file dunng the G��y lb7�r�o�,ITY UDI�fl Counry Recader
Y18
See reverse side lor addiLOnal insWClions and qualilrcations. � e I K �
Applrant (owner 6r aontraC buyer - sre m revsLS� side) /J / _
y� � U �
Assesse0 rahre of 2a1 pmperty as of 8e / Contraa nnss unpaid a of Mortgage 1 Con7-ad
�MeRh 1. tlrrer� year �j�, Wrtenl date of aPP��
If ro. what is his! hx exad share of interest?
� �-U -i a -/D .3 -aQo . 0� 6 -
tl name m remN'a 6FUent ihan Nat of appOmnl, trdzate bebr.
Name of mort9a9� n cono-aG
rtnrt9a9ee or
w otnel owner or
of mortgage
state, ard LP code)
oi assignee (num6cr entl stree( ray, stefe, antl Z/P code)
Does epplitani ovm property in any oNer I I( yes.
munry in IfWiana? ❑ Yes
❑ No
20
Sg�aNre W Caunry Auditw
COUNTY A�
RecoN number _ � Pa9e numbef
iita6le ame(1
Yes ❑ No
�.�,.^r.'.
ya��e arooertr �n a�a,: a,�oy nsscssee
is`eaiProPertY ❑ Mnua➢YAssessed
Dra��•er NO....°��..!.....
Card NO. °� 5 3�
� qp,� .................
20 _ � 20 � 2� _ � �
Caunry
20
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20
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I I We certify under the penatty of perjury that Ne above and foregoing infortnation is We and cortec[ ard Nat the applitani is a msident of IMiana arW
owner I contract buyer of the aforemeritroned property on date appliption is filed.
Ranue (o�x�erY fiID �/ Date (monlh. daY. Y��
i � /,7i- �e /// it .�
W appf�nt �.. r antl stree( dry, state. and Z!P ootle)
z. � .Q rum �� ��
tlWy ez�PorerW Attm�ey m Dy IC 61.1-12-0.7
PGtlr� ot autlar'ved person (num0er and sbee4 uN, �re.
D3te (rtron(h. 03Y Y��
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