HomeMy WebLinkAboutMortgage_Reising (3)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�__ ; FOR DEDUCTION FROM ASSESSED VALUATION
Siate FOrtn 43709 (R71 / 6-09)
�' l Pmsoibed Ey Departmem ot l.aral Govemment Fu�ance
�
INSTRUCTIONS: �n 99� gggeeedddwrth
To be �led in person or by mail wifh the Counry Auditor or Counry Recorder o! fhe county where the property is IocateW N F a L y-I U�
Filing Dates: i) Real Property: Must file during the year /or which the deduction is soughl. LT County Auditor
2) Mo6i/e / Manufactmed Homes not assessed as Real Property: Must fi/e dunng the hveNe (72) mon_ ths j I-1 �nty Recorder
6efore March 37 0/ each year the deduction rs sought. �Y a �
See reverse side fur addilional insVUCtions arid qualrfications.
App6ray.�ownermc°"fiaStEuye�i�e rerersesiie)1 � . > —
sessed vaLe d mdl P�P�Y az�
m
art31 1, 0.lRfR yeN
no, what a his / her exatl shara of interest?
��-� �- ��-�
Mpr�q�ge / Contraa ibe6teanPSs
Mardi 1. a�rtent yeer
name on rt.md is tliRerent than Nat o( appOran4 m7itate 6ebW
Name o1 mongagee or
Adtlress W rtnm�agee or contracl se�er (num6er aM svaeG �Rl: sta�,
Name of astiryire w othnl owner w hdder of rtqngage
(number aM streef, cdy, state, arM Z/P cotle)
Oces epplifant own yoperty in any other
counry m In0'ena? ❑ Yes
���,
�_ , �
I( yes,
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r n — ri[�
Mortgage � Canra
Eate of ePpGmlim
if ovmed vriN someone oNer than
�
� 1 �=�/
JvSt�}-� �
�m y K
Sig�atlire d Camb AuEimr ,i� I I h x /j�
V 1 V � �! / O
I I We certfy under the penalty ofperjury fhat Ihe aDOVe
owner I contracl6uyer of the aforementioned pmperty okaaie appncawn �� ��ti.,.
/ R�O i5 ^ �..�
n
� F I r/evd`nt adtlmss of appficanl (n r antl sfrCee4 �: s7tate, ard ZIP mle) /
(➢J.3Z S 7DnG- / f l)ranL�t .Z� �%�OvB
exewcea aowerarnnm,ey w M�c Fi.t-tz-0.�
AdC2ss of aWiatred parson (num0erarM svice; ciry, sfale.
09 �fy90
�mGaiO as d Is Ihe eOP�t Ne sole
legal w eQuitade ovme/?
❑ Yes ❑ No
idinte with whom
fe pfoperty in Question: Mnuaaj Assesud
Reai Property ❑ MnuallyAssessed
rws mi5 aeauclio� oeen rea�esuw o� v�v
far wrtent yea/? ❑ Y�
___ ❑ No
F;,.
: (rt�mth. day 1^�A
anl is a resident o( Irnliana arM
3I8 �RIOlIi}I. d8y y98�%
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