HomeMy WebLinkAboutMortgage_Dixon (2)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T h r
�__ FOR DEDUCTION FROM ASSESSED VALUATION
� State Form d3709 (R11/6-W )
�` , P2sm'bed by DepartmeM af Lool Govemrtrenl Friance
� File ark
INSTRUCTIONS: r' '� "^
To 6e filed in person or by mail with fhe CountyAudifor or Counry Recorder of the county whe2 the pioperty is bcated. F� � l�� ,�,,
FiRrgDafes: 1)RealPmperty:MUStfifeduringNeyearforwhirhthedeductionissought. GIB ON�UrvT7"�{ ��JR
2J Mo6de / Manufectured Homes not assessed as Real Property Must file dunng the hveAre (12J months
befole Maich 37 of eacA yeur the deduclion is sought. Counry Remder
See reverse sf�ie for additbnal instnictwns and qvalifications.
Andirant (o r ar wntract 6uver- see on reverse sidel
�.1.L��,. .
/��J/.Y/�/�i (D D�
A�sed rdue of 2al P�P�Y � of
MazM 1, W2n[yeer
tt ro, what is his I her exaU share ot ii
H name m �ecaE's dillvmrt than tha
r7ame ot rtnrtqagee «convacc sener
r / legal dztaiption
/3- / �-3o3-oaa.,
Mortpage/ Cantraa irMe6tedness unpaid as of
March 1. wrtent year
6iCicate 6eWw.
Add2a of mM9a9ee a cantrad se0er (mm�Derend sbeeL uN. 5ate. aM LP code)
Name ot
/ ^� I RecoN
(p —W �
t irMeMedness unpaid az a! Is Ne epp6rant the sola
'/ kgal or eqUiNAble rnvnell
� �Y�� �a ❑ Yes ❑ No
tlun spouse, IMicata wl�h whom
Is Cce property in puestion: Mnualty As5e55ed
Reai �openy ❑ tvm�nyass�,ed
ACtlress ot atsgnce (numDer antl avee4 �ry: s+ate, e
Does apd�,nt own P�DeM in any oiher �� L� f/ � �Q%i Has Nis tleduUion Eeen re9ue5teE on properiy
counry m indana? ❑ NO Af ' tw artem Ye�! ❑ I
❑ Yes � � � I�1 0� "v _ _-. �� ❑ Yes
Dr�ucrion aPW� 6� Me
20 _
sigruwe w Camb /waimr
20 _
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Gra� R'a%�'`� 20 _ 20 _
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II I We certify under the penaliy of perjury that the above and foregoing infortnatlon is we and correa and that the applinnt is a resident of Indiana aM
owner I contract buyer of �he atorementioned pmperty on date applicatlon is filed.
xSi�n�wra (owne/s hA� __ �' Date (monN. deY• Yae�
J I FW 2siEem
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Persm
stdte,
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�� �„�,�. �y,�o
o( auNOraed persm (numDer aM sbeet dN. s+ate. anE LP cade) . —. . I���