HomeMy WebLinkAboutMortgage_Phillips (3)s w� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES:
FOR DEDUCTION FROM ASSESSED VALUATION
State Fam 43709 (RB / 2-07) .
�' .•„ � Presmbed bp DePertment of laml Govemmerrt Firmnce
lNS7RUCTIONS:
To be filed in parson w by mad wifh Me CourMyAuditor W the couirty where the pioperty is bcated.
Fding Dates: 1 f Real Property: Durtng the 12 months be/ore Jurre 71 d the yrear the dedution is to be effectiva.^Dn
2j Mo6�7e Homes assessed w�dar IC 6-1.1-7: Behveen January 15 end March 2 of the year Me dedtltb�n i� to��Sve.
See reverse side for addiLOnal insWCtions e�W qualificatinns.
�
Appica�orner oi mnhad 6uyei %se�e r'4rirbons m raJerse siee) �
7" Di 'd . Key twmber % leybl desaipGOn R�� ^ P� ^�^�
� -oa 30 - 3 $
w�d ��e ot rea� po�ertr � d rna� i. arreni r�• Abrtgaye / Contrari indebtedness unPaid as of March 1. Is the app6ont the sde legal ar equitable wrtiell
airrerrt year
y c ❑ No
If rv� what is his / her e�cl share of iMerest? If owneA wtth sort�ew�e dher Uun spouse, vdicate wilh whom.
If reme m recwA is d'Aferenl U�an that d appliprq, i�mte belox. Is Ihe propeM1y in 9�Gm:
�I Property ❑ Moble hbrtie QC 6-1.1
Name o1 rnutgagee or mNad selier /J
l
ndd�ess af mongagee or oonuaa sellu (iwmber ara w
Narne of assignee a aher owner w hdder d mMgage
Address of assignee (rnmbei end s6eet �l: state. and
Does applicaN a«n property in eiry alhei
county in Indmrel �
❑ Yes ❑ No
stafe,
If yes, what counly7
COUNTYAUDROR
Pl�l�/.[S%� � _-
ES Y
C�D� k ,a
DeducUon approved in the amwnt of: � ����/
2p �_ 20 _ 20 2b _ 20 _ 20 2u _
Signature of Caunblwd�or � CauntY Date (rtnnth. OaY• Y��
I/ We iertify under the penalty ot perjury Mat the above and foregoing infmnaGon is true and mrrect and Uiat the appGCants was / we2 a resident of
IrWiana and owner of ihe atorementioned property on March 1, 20 _
4appvaiu (num�6�e/l and'sLaet ch: ��e. ane zrr mde)
:ACr ///[2A�L vc;'!Gr
f�y exea,�ed aowe. u�arna «ny �c 61.1-t2-.o7
persm (num6er an0 sbeef. cdy, sfate, aM ZIP oode)
Date (mmfh. day.