HomeMy WebLinkAboutMortgage_Georges^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
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s FOR DEDUCTION FROM ASSESSED VALUATION
• Slate Fom193709 (R71 / 609)
�' ,,,, ` P25ai0eE by DepartmeM of laml Governmenl Fitance
INSTRUCTIONS:
To 6e filed in person or 6y mail with the CountyAudita or Counry Recorde� o/ Ne counry where the property is locat .
Filing Dates: 7) Real Properry: Must file durirg the yrear (or which the deduction is saght.
2J Mobde / Manufactured Homes rrot assessed as Real Properly Must file dunng the lweNe (72J monMs
before March 37 0! eaGr year the deduction is sotqht.
See 2verse side for additional insWCfions and qualfications. C
AppGC2nt (own conUact 6uyer- 5ee ShPl:ons m reverse sid �
�_ � r��$nl
Taajaq,Oistrin Key�wmp egaldescript»n rd
I/ no, what is his / her era�Y share ot interest?
If fwre m rewrd is dilfeRnl ihan ihat o( applNam, u�tlirare bebw.
Name oi mortgagee or mntrari
Address of rtwrtgagee a contra
mortgage
I
nAaress ot atsgnee (numceialro suee4 c% s+ere. am ur caae�
Does appiiraN rnm WoP�Y in any dher If yrs. whal
counry in IMa�ap r� _. . r-� ..
amoum of:
di/I r I
�
tt owrretl wiN someone aher ihan
��oa�ES, �,,.�� s�-/� -
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1
Year
�e C[pUy�1(�y Auditnr
� County Recorder
Page numbrl
I u Y� u No
vrt�om
stion: Mnually Assessed
❑ %vmual�Y PssesSed
stea m G�W�Y
Yes ❑ No
I 5h-� 20 20 _ 20 20 20 20 _
`7 �
�nature d CamN Auditor Counry Date (r+mfh. EaY. Y�/)
I/ We ceNfy under ihe penalty of perjury that the above aM foregoing infwmalion is We and corteq and �hat ihe applicant is a residerrt of Indiana aM
owner / contract buyer of Ne aforementioned property an date applicalion is filed.
v�ae�re la 'EAl �mel . � _ Dare (rtmfh. dev. werl
iEmt address o( a t(number ar reet. rily, slsee /P oode) N���
3/62�GSoE,%rah 's ,/ �f
aWn�¢etl Dy dWy exeCUtetl Power d AtlomeY a bY I -12-0.7
s of author'ved person (number antl sbee4 �'. sfa(e. and ZIP oode) .
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