HomeMy WebLinkAboutMortgage_Lunceford^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
,_. FOR DEDUCTION FROM ASSESSED VALUATION
. . Stale Fam C3709 (R11 / 6-09) T
•,' � Presrnbed Gy �epaNrieM of L.aml Govemment Fuance ����
�� File Mark
lSTRUC110NS:
To 6e filed in person or by mail with the CowtyAuditor or Counry Recorder o( the county�f/� {�h �fu RL located F� m� �:
Fdirg Dates: 1) Real PropeRy Must file durirrg the year Por which fha detluclion is 5oughtU �, 1�� � �� � Counry Auditor
2J Mo6de / Manufactured Homes rwt assessed as Real Property: Must file during the fweNe (12) months
before March 31 of each year the deduction is soughf. C.�. � ❑ County Recorder
See ieverse side 7or additional instrtictions arrd qualifications. \
Asses� raLe d real PoP�Y as o(
Ma�ch 1, Nmrt yeN
R ra, what Is his ! her exad share of in�i�st?
It nartre on mco�d is diRerent Nan that o( aPpl
ii!//Il
L�.w_� �-� --�� —..
Name af mortgagee w contraa selier F j�
✓
Address of rtnrtgagee w wntraG 5e0er (nwMr.r and sbeet, cdy, state, and ZIP code)
name o� azsgnee w omer owner or �noer or mortgage
AEd2ss of asvgnee (num6er arM stma(, dry, slate, eim
Oces apdimN own P�PeRY in any other
����m����
zo �
Sig�uh�re W Caunb Audimr
I/ We certify nder Ne penalry of perjury
owner I co cl bu of Ne aforementic
)
I
FWI 'tl ntaEdresso a t mbera
B ,ti � c
Puson autM�aeE by dWy exewced Power' Attc
AECmss of auU�omsd person (numDer and stree�
ircme�
Y�. �
Rem(d nurtiEri
date of appl�tion legal w equitaCle own�i
❑ Yes ❑ NO
If ovmed vriN sumeone aher ihan spasse. i(bicate with whom
Is the property in Que50on: MnuaDy Asessed
❑ Real Rovertv ❑ Armi+alN Assessed . . _
�O l �
ul':l1\'�1' �� ...................
� y95a
Cal'CI NO . .....................
COUNTYAU r-�(3� �, � � 53, 9 y 5, pO—
�5
20_ 2�_ 2� 2� 2�_
Caunry Date (rtpnN. daY. Y�A
�he ve and foregoing infortnation is true and correct and that the applirant is a resident oi Indiana ard
) p rty on date applicadon is filed.
aty, sfate, and LP mOeJ
r ar Dy IC 61.1-12-0.7
r, sfat& aM LP cade)
Date (nionth. daY.