HomeMy WebLinkAboutMortgage_Holderbaugh^'�4 $TATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year `
� FOR DEDUCTION FROM ASSESSED VALUATION
• State Form C3709 (R71 / 609)
•� w. I Presrnbe0 q �epartmeru o1 Local Govemment Firemx
Fil
INSTRUCT70N5:
To be filed in rson w b mad with the Coun Auditor o� Cuun Recorder of the coun where the m F� u" j�
Pe Y N N � P PeNY is bcated. �ni�y �a�
Fifirg Dates: 7) Real Property.' Must file durirg the year /or which the deducfion is so ht
2) Mobde /Manufadured Homes rrot assessed as Real Property. Must Tile during the hvelve (72) months
6efore March 31 of each year the deduclion is sought. - ��� e�
See ieverse side 7or addiGonal instnuUons and qualifications.
iwm6er / le9al
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ntsesse0 vanie oF rral
MaU 1. arran year �Y �� N
11 ro. what Is Itis! her erarY shara of interesi?
It rwria m remrd's dA(urnt Nan Nat of aDP�L
Name M moR9a9ee or contrarl se0er
Addres of mortga9ee ar mntraG seller (mm6rJan
Name oi asi�ea w mher awnu w holder of mortg
Aedress ot assignce yumber aM sLeef, pry, s7E2,
Does ePplirant ovm pmperty in eny oNer
counry m Indona?
❑ Yes ❑ No
zo _ 20
Ire4rte ot Co�mb AuOitor
I/ We cerOfy uMer e n
ownerlcontracl6 fth
� re owrier5 n )
� d appf t
rson auNOrtred Ey OWy ezewU
� l �O
Intlehtedness unpaid as ot Mort
v— ��
tt owned wiN someone aher tlian spoiae,
z�cu
sta'e. aMLPmde)
� , �y
DI'a1ti'CI' 1���.. �v�
. �.......
Cal'd \`O. ... J�1D�
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ET�c'y ��o,�o, �o
zo _ � zo , _ _
County
Recard number � Paga number
Yes L1 No
h tice OroPertY in Quesuon: MnuaDyASSe�ed
� Real ProPeKY ❑ ����Y�
Has Iha deduUion been re9uested m pioperty
tor arterrt Y�n r-� .. r-�
z°— � 2°—
yea�
perjury that the above and foregoing in(ortnalion is We and corteG arid ihat the appliont is a resident of Indtana aM
amentioned property un, date applicatlon is filed.
arM LP catle)
Add25so(authwaetlperson (num6erandSfraeS�l:sbte,a�LPCOde) _ ,
o� (r,�,u�, day,