HomeMy WebLinkAboutMortgage_Mull (2)-"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ FOR DEDUCTION FROM ASSESSED VALUATION
� � Sfate Fwm A3709 (R71 / 6-09)
S � Presrnbed M �eP��N of Local Govemment Fi`w�ce
u�.
iNSrRUCnoNS:
To be filed in person w by mail wi[h the CountyAUditor or Counry Recorder of fhe county wAere the pmperty is located.
FiNrg Dafes: i) Real Property: Must file dunng the yea� fo� which the deduclion is sought.
2) Mo6de / Manufactured Hortres rrot assessed as Real Property: Must file dunng the twelve (12J montAs
betore Maich 31 of each year ihe deduction is sought.
See reve� side for additional instnm.tnons and qualfications.
uditor
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�AppGCan rormn7raCbuyens°eleslr�rtaram�versesdal GIB v v
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A� ralue d real P�P�Y as ot Mor(gage / Contraa 4Wehtetln�
Mart�h 1. qa'enl year MarrJ� 1, airtent year
tt M. W�19� 6 �15 � �1P12%df15�13f0 Oi Illi2fflSi7
1f name m remd is dMemnt ttan Nat ot app6wiL mdinle be7ovr.
Name ot rtart9agee or mntrarl sener� �.
AEtlress of rtwngagee w contrad seller (nwnber and stre
w omer owner or naaer m mortgage
� SON COUNTY q�DIT
Reooitl numbu Page numbel
y. ��3-01,7 aol� �t�93-
i az of Mortgege / Contraci mdebtedness unpai0 as of Is Ne eppfrtant Ne sde
Oate of apPUp�ron lepal or equitade ameR
4 O (� ❑ Yes ❑ No
tt owned with mmear�e Ihan spouse, iMirate wiM wfrom
Is tM V�Pert1' in VuPStidL MmiaDY Assessed
[�Reai PmPenY ❑ AmuaOY.A�sed . . _
Aa ot assgnee (numcer ana suee; cay, siate, ara ��r cooe)
i.� N �v �y- a-�i , y 38 � c
pres apd�u � G�P�`/ in any oNer If yes. wha[ cuuntyl What Tadn9 DisUict7
caunry m inanna? n..�. n u,.
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�nanne d Counb nwimr
C' -T. )/Iti.sy
1/ We certify under the pen
owner I mntract buyer of th
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Dra���er NO... ??.� � .....
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7" — / I Cou�N I Date (�mW. daY. Y��)
of perjury that e above and (oregoing infortnation is we and correc[ and that the applicant is a resident of Indiana aM
wemention p�operty on date appiication is filed.
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� FW resiAeni a ress of a� t(n, ;�r a� sLee4 aN �te, and LPca
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Persm auNw'sed by dUy exearted Power al Avart�ey or Dy IC 67.1-12-0.7
Pdtlress of authw¢ed person (numberantl sCee4 �+N, state, anC LP mde)
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Date (monlh. daY Y��