HomeMy WebLinkAboutMortgage_Doane.� °°� STATEMENT OF MORTGAGE OR CONTRACT INDE
FOR DEDUCTION FROM ASSESSED VALUATION
Slale Fam 43709 (R8 / 2-07)
�' ,,,, 1 Presrnbed by DepaNnent W Lacal GoVemment Finance
��
Coun Township Year
File Mark
INS7RUC770NS:
To be filed in person or 6y maa wrfh the CountyAuditor ol tfre couMy where the piopeRy is located. �
Fd'urg Dafes: 1J Real PropeAy Dunng the 12 monMs betore June 17 W fhe year the deduction is to be elfecfive. 1
2) Mobile Homes assessed wMer IC 61. 7-7: Behveen January 15 and Marclr 2 0/ the year the deduction is to be et/ective. V1 �
See reverse side /or additional ins6vctions ard qualificafions.
Apqi�ant eiorwn x se
T ' sfriti Keysu
Ci1
rdue aF real as d March 1, �
If��at is hs / her exacl share of interest?
If reme m recorU is different U�an �hal oF appl
Name of rmrtgagee or conUacl sdler ��
' Q � ^ -GZ7
�Y� �9e / Conirad'mdabledness unPaid as af March 1,
aR�„���� 9 y 9
If ownad wiUi someme alhe�
mongagee « cono-aa selle. (numaerand street dA: ��a. ano
of assignee or alher oa�x+w hdder of malgage
assgnee (rnuMer arrd s6eet �: stafe.
ooss appicarn own aropem �n a�,y ou,er
counry in I�Wia�?
❑Yes ❑ No
Deduction appmved in Ne amaunt of:
�
SignaW re of Counry AudMr
If yes, what camtyl
�
What Taw�g
COUNTYAUDROR
_�ti�
I I We certify under the penalty of perjury ihat the above and foregoing ir
Indiana and owner of the afwemenfimed property on March 1, 20 _
(niunber and street aTy. sfate. and ZIP oode)
JOOJ �r'4hclS��l
�d r� �ru�y « ey ic b�.i-i2-.o�
authonzed persai (nurnber and s4eet, oty, sfafe. arM
Rewrd number
a equltade wmeri
❑Yes ❑No
inditate wiUi whom.
property in questim:
al Procerlv O Mobile Hane (IC 67.
20 _ � 20
Cam1Y ��
p�\Cl' 1��q.........
11��
Cara��'�58,9'�9.� �....
1
uesred on property
❑Yes ❑No
20
Y.Yea�
vere a resident of
Yee�1
Y. Yee�)