HomeMy WebLinkAboutMortgage_Price (7)'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,_ FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn A3709 (R11 I 6-09)
1 w. Presaibetl M DeVartmenl of Lo�l GovemmeN Finance �
File Mark
INSTRUCTIONS:
To be filed in person or by mail witA tAe CounryAuditor or Counry Recader o( the county where the pmperty is located.
Fi7fig Dates: 7) Real Proparty Must (le dunng the year lor which the deduction is sought.
2) Mo6de / Manufadured Homes not essessed as Real Properfy Must h7e dunrg Me tweNe (72) months
6efire March 31 ot exh year the deduction is mught.
See reverse side /or addifional instructions and oueliffrations.
Counry Auditor
(]�t •�� � KeY nur�6er/.legal desrn'ptim� �_ M, � Remd num O Pa9e n
�.� % dl0 l l ��^
ed.aWe af mal popeny az d Matpape / Contract iritlebtedness unpaid as of Mangage I ContraG trMebteMess �mGaid as d Is Ne aPP�t the sole
1. Wient year Merch 7. Wtyaqt ypg�'1_ O Eete of aPP�� �I O YPS ❑ eNo
� `YG/'\
OC �7._7�J
ro, what is h'a I hw eu�t share oi interest?
name m 2ooid is Q`Ilermt ihan thal ol aPPPpnt trWkate Eebw
�
ar aontract
Name of assignee a �
Ada�ess ot atagnee �
Dors aPpti�N wm p
couMy m IM'ana?
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20 _
E
I/W¢cert UM
owner/contracl
��aW (owne/s/u
.�W resi0errt a0tlmss
ar mntraU u0u (num6er end sbee{ r�ty, sfete.
' ��ll"� �� �' �--�C.
-� �tQ - 1�JQ
s8'ow P��n��
exetutetl Pwrer of AttOrney v by IC 61.
MEress of authar'¢ed person (number e�M sbeef, dry. stafe.
If awned wiN mneone oNer Nan spaae. md'�le wtrh wMm
,�
Is ihe pope�ty in question: M`waDy Assessed
❑ Real ProPertY Q %vmuallY Psse55ed
dedutSOn Deen �WUat� m praperty
� � ❑ Yes ❑ No
�_ �_
Date (mDlWI daY.S'Pa4 . �
We and corteU arW that Me applinnt is a resident of IrWiana aM
Date (rtionfh. daY• N��
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