HomeMy WebLinkAboutMortgage_Lemeron^��+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun o ship Y
: FOR DEDUCTION FROM ASSESSED VALUATION
�r— . .• State Fwm <3709 (R71 / 6-09)
°,,,� � Presrnbed M OePZrtmeM of Local Gwemment Fwrms
ie
INSTRUCTIONS:
Fortn 1�
To be fi(ed in person a by mai7 with tAe CowtyA Wiror orCounry Reco(der of the cnunry where the property is located. �
Filirg Dates: 1) Real PropeAy Must file during Ne yearlor which tha deduction is soughG �u r
2) Mo6i7e /Manufactured Hortres rrot assessed as Real Pruperty Must fiie dunng fhe M1veNe (12) months GIB ON U�lau�i.q��
before March 31 of each year the deduction is �ht i�r
See reverse side (or additional instructions antl qualfications.
MWtG�I(ownerwconNdGbuye�- � , _ _ n . �fl
Key �umber / legal desc
1 / . I '] _
P.s�ssed ralue of real paPenY es d
Marth 1, avrem 1Kar
n �o. �t �s ns i n� � sn�a or �,�
Ii riame on 2rnE a 6fferenllhan fhat ol �
Nam¢ af rtgagee « mntxt seller
Ad� �mortgagce w contract selier (
Name of assignee w oNer ovmer or hdd
Add�es, of as9gnee (number aM sdeet
Does aPplinnt w.n yoperty in any oNer
couniy in Indw�a? ❑ Ye5
Orduction aPWO'� in tlre amount af:
20 20
Sigrehne W Co�mbAiWitw
c�Guate Eeb�r.
Remrtl �m6er � Page
as of I�ortgage /��� trMehtNness unPaid as °1 I�
PP
rc wmea x�J, mmeone omer aw, :pouse.
num6eraMstreeL�l:�.eMLPcrodal.-��� D.
erofrtnn�"" ���\� ��
-/ ��V
ut,; str1e, �'G �� � � �,,1 �
�� 1a, �3�� _
_.. � r AUDROR
20 � 20 _ � 20 _
Caunry
oanM
❑ No
iyM�, propeity in Question: Anm+aM Assessed
R+<eal ProPenY ❑ Nmua��Y `A,sessed_ _ _
H3v I�16 dEdlIfL011
ror wrtem yeaR
20
Date (rtmtti, day, yea�
rn praperty
❑ No
20 _
i I We certfy �Mer ihe penatty of perjury thai the above and foregoing infortnation is we and cortect arM ihat the applirant is a resident of Indwia and
owner I contract buyer of the aforementioned property on date application is fiied.
Sigre�ue flA / Date (morRh. daY.Y�n
l� A / J �Z�/ 2�/'7
p�rant m6e�antl sbeef, �}; state, arM ca
! ,5� � �/S1 .f�
rxewteO Power o(Attomey w Cy IC 61.1-12�.7
auihu'¢ed De�"� (num0erar�G svee4 �: sbte.
C��Y l-'� �' %�i(oD
� c�.