HomeMy WebLinkAboutMortgage_Fears^'3 STATEMENT OF MORTGAGE OR CONTRACT IND��N�SS ou Township Year �
• FOR DEDUCTION FROM ASSESSED VALUATION �
• State Form A3709 (R71 / 6-09)
�` ,w d P�esmbed bl OeP��eM af lopl Govemment Finarnx
JAN 2 Z013 File Mark
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To 6e filed in person or by mail wiM the CowrtyAudi[o� or Counry Recorder o/ the county whe�j e pmp cated F� m� �m:
Fifing Dates: 1) Real Property: Must file dunng the year for which the deduclion is sought.�(/� Counry Audimr
2) Mo6Ae /Manufecfured Homes rrot assessed as Real Properiy Mu��SJurl��C ��5 � Couniy Recorder
beloreMa/ch37ofeachyearthedeductionissoughG UKL T AUDITOR
See reverse side /or additional lnstnictions and Qualifications. .
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MaU 1. arrent Year
tcey�nxnoer� eesvi n«, Rem�dnumCrl
�6-ia- a �-�o��soo-o�t� o_
Mo�qage/ Con� inde6tetlness unpaid as of Mortgage / Conbart mdebteEness unpaid as of Is Ne
Mard� 1. artg��� O Vi J date of aGPOcstion legal �
II m. what Is his I her e�oa shara Ot interest?
If name on remN is drtfuen[ ihan Nat of app0�ant h�d'uale Eelow:
tJZme of mortgagee w contraG se9er
/
Add2a of mortga9ee w mntraG seller (num6er arid saeeL �R}: state, aM
Nama of assignee or othrl owner w holdel N mortpage
Addmss ot assignce (number antl atree4 atv a�•.. _-' `— �
_ _ _ �
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INTY AUOROR
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SignaNre af �ma -' o
I I We certify under the penalty of p� ury Ihat the above
owner I mntrac[ buyer of the aforementioned property
� re�, �um„�»Q.a/ • �1dcr/2-,
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`W^I resi ent edE�re1ss of appfimnt L(numberaritl sLee4 ml: ��e, arx
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Prlson authu'¢ed �y d�Ay esa�etl Power olAttpney w by IC 61.1
Pdd2ss af auNOraed persOn (numDer antl5be8L �Y. state,
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someane oNer tlian spouse,
Is ihe pioperry in Question: Mnu�
� Real PfOpefty ❑ Amtual
MobBe
Iror wrrem r�n
2�_ 2�_
�f �.. ,. _ oate (rtrmth,
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Yes LI No
sled m P�Y
Yes ❑ I
�o
nd foregoing informatlon is We and corteU and that the applirant is a resident of Indiana afxl
date application is 51ed.
Date (mar+lh. daY• Y��
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