HomeMy WebLinkAboutMortgage_Blum"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
� Slata Fam C3709IR71 / 6O9)
�' � Presvibed by DepaMreM af Lo�l Govemment Flnanm �
e
INSTRUCTIONS:
Farm Ned witA:
To be filed in person or by mail wiN the CountyAuditor or Counry Recorder oi the oounty where the property is Iocat�AY
F7ing Dates: 1) Real PropeRy: Must file durirg the year for wliich !he deduclion is soughL � � unry Auditor
2) MobBe / Manufactumd Homes rat assessed as Real Prope/1y Must h7e dunrg Me IweNe (72) monfhs ❑
befora March 31 of each year the dedudion is saqht. Caunty Reoordu
See `everse side for addifion�f instnxtions d qualifications. ��
qyprrant(owreror buyer-see versevee) COUNTY AllniTnR
•• • �/����a��� � _���'� �. C>�Y�I..IJ Record Pagewmbu
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�ed va4ie oF real of t�r(p� ge/ Canbaa 4debtedness unpaid as of Mongaga / ContraG inOebteCness unpaid av of Is Na ePP��t the sde �
erth 1. a+m�c Year Mar�h 1. ainenr��ce�/ Oate of aPP�� legal or eWita6le owneR
`J 1 O� ❑ Yes ❑ No
fro. what is his / her e�act share of inNiest? It awned xiN mmeane aher tl�an spouse. iMimte wRh wtom
H name m remN ia 6tfrrnnt than Mat o( appOrant
Nama ot mortgagea «
rrortga9ee u cantrari
Is Ne D�DP+�Y in 7urstim: MnusA' Assessed
❑ Real Property Q Armually Assessed
Moble Home fIC 61.
cdy, sbm, eld LP code)
Name of assignee w other owner or hdder ot mvtgage
PdEress of astignce (number aN streeL �Y• �. and ZIP code)
Ooey ePpfirrnt wm poperty in any other If yes. what munt�/1
counry m IMana? ❑ Yes ❑ No
DeEUCOOn approved in itre amount ot
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I/Wf
awne
SlpnaNrt
P t.�7/ YI.iA (L�L�lYI
FWI 25iCent etltlrass W appficant (numDerantl sLeeL o1Y, sble, aM LP ad
� �3��' w. ��.0 Sr � oa,�
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MEress of autlia¢ed person (number aM sbaet �: sfate, an0 ZIP mtla)
Has Na tledumon Daen re9uated m pmpelty
far arreM Y�r I—I .,_ _ !"t
6bIII:fiTi[�I�L[�1:7
zo _ � zo � zo _ � zo
ICounry ��.�1��„�.�'=°�ti -t
ing infortnalion is true and cortect arM ihat the applirant is a resident of IfMiana and
rcation is filed.
Date (monfi. deY. Y��
Date (�1h. d�y Y��