HomeMy WebLinkAboutMortgage_Brown (12)"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__., : FOR DEDUCTION FROM ASSESSED VALUATION
• State Fam 63709 (R11 / 6-09)
, w�. � Presrnbed by �ePa�M of Laml Gwemment Funnce
File Mark
INSTRUCTIONS .
To 6e (led in person or by mai/ wi(h the CounryAuditw or Counry Recorder ol the counry where the poperty is located.
Fi7irg Dafes: i) Real Pmperty: Must file during the year for which tha deducfion is sought.
2) Mo6de / Manufaduied Homes rat assessed as Real Property Musf file dunng the fwelve (12) months
6efae March 37 0/ each year the deduclian is sought.
Seeieverseside(oq6dditionalinstmctionsarrdQuali�cafinns. /'� r_iaer
Counry Auditor
Qounty Recorder
�strirl Key rw�hCer'! al ErsaipUm Record nu Page num
- �- -000. Ol3- OOI ��i �(�
1 vaNe of rnal pfoperty as d Mortgage/ Contraa irde6tetlness unpaitl az of Morigage I Contraa iMe6ledness unpaid as of Is Ne appllcant Me sole
cvrenf fmr March 1. aurem yeg� '�� t) date o( aOP�� �I n Yese ameY+
��� 1
110. W�18� 6 �VS � i12! EY3d S�IdR O� III{PRSI�
If rwne m remC is dAferent lnan Naf d aDP���• mditate below
Name o1 rtwrt9a9ee or conVad se4er
mortqagee «conaaa
ovmer w twlder of mortgage
Mtlrass of assignee (numEer entl atrec; rdy, slete, arM ZIP catle)
Doe� epplimnt wm property in any oNer
couNy m IeWiana? r-� _ _
20
I/ We ceNty under ihe {�nalry of
owner / mntraU buyer o�the afor
If owned with someone other than spouse,
aM LP code)
D'striq?
� D�.�iverr\'p o� —
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i Ne above and foregoing in(ortna�....
on property on date applicalion is filed.
dry, statg ary z�Q cade)
dWy esecuteG Power otAttorney m G/ IC 61.
sLeet. cn}; state. aM ZIP code)
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I5 Me properry in Question: MnuaOy Asessetl
� Real Roperry ❑ MnUally Pssessed
MoWle Fiane fIC 6
Has �ha dedudim Eeen reQUesteE on proprlty
far curtent yeaY.+ O I
❑ Yes
_ 2� 20 _
oa�e (�r. rz�l
cortecl and ihat the applirant is a resident of Indiana arW
Date (month. daY. Y��)
�'7G �D
oa� c,�,m. e�,-. �o