HomeMy WebLinkAboutMortgage_Johnson"'3 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co wns v
__ FOR DEDUCTION FROM ASSESSED VALUATION
� Stata Fortn d3709 (R71 / 6W)
�„„ � Prescibed Gy Department oi Lacal Govemrtrent Fnance
INSTRUCT70NS: � LO,L
Farm fled wiih:
To 6e filed in person w by mail with the CountyAUditor or Counry Recorder oi fhe counry whe2 the property is bcated.
Fitirg Dates: 1) Real Pmperty Must file dunng fhe year for which the deduction is mught. �- ��� dimr
2) Mobde / ManuFaUured Homes rrot assessed as Real Properly Must file dunrg the hveNe (72) monfhs
before March 31 0( each year the deduction is saght. • ❑ �W ty
G�g NTY AUDIT �
See Ieverse " e 7or additnonal instructions arxl qu fications.
nppifant � con b r- e rastn'rlfons m srtle)
U iL (J� �
Tawg �i ' Key ruanCU / 1e9a1 desaip' �, RecorE number P n mbu
Assssed ralue of 2al P�P�Y %z �
Marh 1, ament year
If ro, what is ha / her euct share ol
11 nart�e m rem�tl
artent yea
unpaid as of
���� � i � �
mortgagce w mntract seAer (nwnba� eM sLee; crty, stale, aM Z/P code)
Name ot assignee w other owner or twitler o1 fmrtgage
MAress of assignee (numDer aM stree; tly, state,
property in any oNer
❑ Ves ❑ No
Deductiwi appraved'c� tlm amount
zo � zo
Sig�uWre of CounryAUtlitw
If yes, whal munt�/1
.Fi��
someone
o�GQ �% /
unDaiO as o( Is Ne ePP���t the sde
legal w cyuitaNe o.me�lt
�(� ❑ r� ❑ No
spouse,
Is tlie pmperty in QuesUOn: MnuaDy PssesseE
❑ R� ao�nv p nr��y a�ua
� P�rtY
❑ No
)UNT.........
— Dra��'er NO...�O��
zo_ C�rd NO. >o
.... �� ............. . —
I �:w�ny � Date (monfh, daY.Y�a�
I I We certify undu Ne penalry of perjury that the above anG foregoing intortnatim is We and correc[ arM lhat the applinnt is a 2sident of Indiana aM
awner I contract buyer of the aforementioned pmperty on date application is filed.
I ,gI
� Full
author'vetl person (numbe� aM sbee4 uN. ��. antl LP mde)
i 3 �� �,�,�, �Y ,��