HomeMy WebLinkAboutMortgage_Haynes (2)^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
__ - FOR DEDUCTION FROM ASSESSED VALUATION
.• Sfa[e Fom A3709 (R11 / 6-09)
S� ! pre�bed by OePa�r�t of Lnml Govemment Financa
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�rRUCnoNS: p
To 6e filed in person or by mad witlr the CourttyAuditor or Counry Recorder of the county where the properfy is located. � 1�� � 2
Fi/ir�g Dates: 1) Real PropeAy: Must fi!e during fhe year for which tha deduction is sought. �� Counry Auditor
2) Mo6r7e / Manufactured Homes not assessed es Real Ploperty: Must R� e dunng Me tweHe (}2J months
6efore March 31 of each year the deduction is sought ��� Recorde�
See reverse side !or addifional instrucfions arM qualifications. '
MP�?�� (��++ef'�^�d 6N� ;� fe�3'SP«3G4�9verse side)
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an 2md's ddtuent Uan Nat of aPP��. trtlkate Oebw:
Name of mor�qagee or a
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AnaresS ot asv9�e �nvmcer arm sveet �Y. s+ae, ena tir cooe)
Does applimnt ovm properry in any oiher If yes, what munty?
munb in I�'era? ❑ Ye5
❑ No
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20
amount
2� � 2(1 � Za
tl owneE w'r.n sommne oiher a
W�at Ta�dng �4tr
Record num0er
tl as d Ls Ne appGrant the sole
U` legal w M����e amet!
❑ Yes ❑ No
9 WICI Nfi0ff1
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1�'Y,,`�
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- ao�� -
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Sigrenne w coimb na,oacr I[:aunry
1! We certity under Ne penalty of perjury that the above and foregoing intortnalion is W e an
owner I mntrad buyer of the aforeme�oned property on date application is filed.
raa� ot a�mor¢ea v�on
]1nDe� aM ST¢ef, tl]J, sfate, MC LP m
tceton IlV `f7670
Power W Attortiey ar by IC G7.1-12-0.7
Serand StreeG �y. sbte, end LP code)
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