HomeMy WebLinkAboutMortgage_Browning^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
:._—.
� FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 437091R71 / 6-09)
�` ,� d Pr¢soihed by Department of Local Government Frence
File Mark
INSTRUCTIONS:
A
To 6e filed in person w by mail wifh the CounryAudi(or or Couny Recorder o! the county whe�e the pioperty is located. �
Fil"mg Dates: 1 J Real Property: Must file during the year lor which the deducfion is sought. d'rtor
2) Mobde /Manulactured Homes rrot assessed as Real Properfy Must file dunng the tweNe (12) months ❑
before Mamh 37 of each year the deduction is saght. e�
See 2verse side foradddional inshuctians arM qualifications. GIBS �
AppGpnf rarconvarl6yrer-`s�eeie4ncfions versesltle) ' � N.
7, /. ✓/`-' .
� p�p�q - Key �wmher / legal desaiDtim � Record num6er Page nu
- 3- U.o a- o� o�a v
Assessed rWue aF real properY as d Mortga9e / Contraa inde6te0rress unP� as of Mutgage I ContraC" unFaid as d ls Ne ePP��t Ue sale
Ma�C� 1, m�mt Ym Ma�tli 1, airtent Y� date of eGP� � � � w eWttaWe ovmeR
❑ Yes ❑ No
If rw. what a his / �er exaa share ot inferest? It oxmeC wiN mmeo� aher Ihan spouse. indirate wiih whom
It riame m record "a dilfurnt than Nat of appbran4 mdipte EeloH- Is tM properry in pues0on: Mmu�y Assessed
Reai PropeM ❑ nmualN �
Moble Home QC 61.1-7)
�ame of mortBa9ee or mntract se�er
AGdress of irort9agce w contraa seller (numbra and t, cdy, sfat , and ZIP code)
Name of zssi9�ee or other wmer w hoiEer of mort9age "�_ --' — —'—
PA�ress of auignea (number ad 51reeC rny, 51ate. and ZIP catle)
�oes appli�ant ovm p�openy in any oNer I( yes. what count�? What Ta�dlg Distric[? i • .
munryinlnauna? ❑ Y� ❑ No Dra�r�er \0..... .��.......
COUNTYAUDROR Card NO. . ayg�
- ..... ...
De�umm app�oved In ihe amount of: �g$) O� ��
20 � 20 _ 20 _ 20 _ 20 _ 20 _
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5igrenne W Counb Auditor L Counry Date (irwnrh. daY. Y��
I/ We ceRify under the penalry of perjury Nat lhe above and foregoing infortnalion is We and cortea arM that ihe applipnt is a resident of Indiana ard
owner / conVad buyer of �he aforementioned property on date appiication is filed.
(owners )
Date (monfi, dey, yae�
F�A � ent adtlrnss M appfi�ni (nu � sLee �, slate, aM LP catle) �
103� S G� l�� ��.,c�s� s�,. y7��(�I
Person auttro�rzed by tluy ezewted Pm�er otAVaney or by IC 61.1-12-0.7 Date (rtmN, day. yea�
�ress of aWror'¢ed persm (numberard sbee4 m1; sbte. and ZIP mde) .
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