HomeMy WebLinkAboutMortgage_Hall (3)^°* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__._ _ FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn C3709 (Ri1 / 6-09)
�' ,.,� � Presaibed by DepartmeM of Lacal GovermieN Finarce
�YSTRUCiIONS:
To be fJed in person or by mail wifh the CountyAUditor or Counry Recader o/ the county where [he pmperty is bcated.
Fil"rtg Dates: 7) Real Property: Must !le dunng the year (or which the deduction is wughf.
2J Mo6Ae / Manufectufed Homes not assessed as Real Property Must file dunng the nveNe (12) rtanths
bePore March 31 0! each year the deduction is sought.
See reverse side for addiGOnal instructions and quali�cations.
' r contrarl6uyer-seeresvirlionsmre side) �B:
Form f�ed wtth:
�T � �Ob�tyAuditor
� ,.,��v-.CounN Recarder
Ta�ung Disbid Ke number / legal Gesciplan Remrtl number Page wmber
�o.... �(�-i 7-.� q- /DO -OC� Jr3�. ��/ eL
If ro, what a his / her erar� shara of interest'+ �
If narne on recoN is tliRerent Ihan ihat ot aPPlipnt. mditate Gelrnr.
Name W mort9a9ce or mntract seller
mwtgagee a aontraU se
�,� o� � � a�
m rtwrtgage
ffire,
naaress ot assgnee (numoer ain sneet ary, sre�e. ana c�r caae)
Oce5 �M wm pmperty in eny oUer If yes, whal
�,^p'�^i^a�"a' n .,__ n .._
20 � 20
I I We certify under the penal
owner / contracl buyer of Ne
dehtetlr�s unPaid as W Mortga9e � w�....,i cidebfcMess �m7� as d Is Ihe aPP rant Me sde
'\ date o( eppfiration Iegal a equita6le ame(.�
O V ❑ Yes ❑ No
H owneE vnM someore ather than wa�. iMicate w%h wMm
Is tlre prope`ty in 7uestion: Mm�a�y Assessed
❑ Real aioveM ❑ Armuallr Assessed
Mob�e Fiome (IC 61.1-�
��— �
K���va "' f�-
I I ��I�'
couNrr auorraR
20 20 20 _ 20 _ 20
Counry Date (monrh. daY. N��)
that ve aM toregdng infortnalim is We and cortect and ihat Ne applipnt is a resideM o( IMiana a�
ned peM � date appfxatlon is filed.
Fidl msitlent atldres d appGrant (nuinbeiarid sheet. �; sfare, and LPtd
BR3a � . � tas t,o. ,xa�,nSv �
Person authwrzed Oy duty esecuted Power of AttomeY � M IC 61.1-12-0.7
Pdtlress of aulhaaeE person (number antl street. ciry, state, aM ZIP ooCe)
Date (rtronN, dey. Y�