HomeMy WebLinkAboutMortgage_Coleman (4)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fwm 43709 (R77 / 6-09)
S�«. � Presaibetl M��nl o/ Ldal GovemmeM Firence
INSTRUCTIONS: a�d
To 6e filed in person w by mail wifh the CounryAUditor or County Recorde� of the county where the piopeM is located. �� V� 009
Frlirg Dates: 7) Real Properry: Must fde dunng Ihe year Por which the deductbn is soughl. � County Auditnr
2) Mob�7e / Manulactured Homes not assessed as Real Property Must file dunng fhe hvefve (72) months
6eto�e March 37 0/ each year the deduclion is snught. ❑� tY Recorde�
See reversa side for addilional instrucUons and qualirications.
IAppli t(o r w contract Duyer- see ee " e) --" �- -
Ta- Districi Keypurpber/� al rsoip' /'��. /' D�� rtlnumber Pagenu�
C.% (O 7 �
Pssesse0 of paperty as M Mortgage I Cantrac[ intlebte0ness unpaid as of Mortgage / Can:raci inO tedr�s unpaiG a ot Is ihe eppGrant ihe sde
Marti� 1, r Mamh 7. wrtent ynar date of appfimtion kgal a equitade wmefl
� ❑ Yes ❑ No
(tt no. what is Ids / her e�a share ol intelestl If awned xriN saneone oNer ttun spaise. md�te wiTh whom
tt rwne m mmd'e diRrlart ttun Nat of aDP�t trMkate helrnr. Is tt�e P�OeM in Ouestion: MnuaOy Assesud
❑ Rea� ProPertY ❑ %vmuallYPscsSed
AloGle Flort�e C 61.7-7)
Name of rtnrtgagee or crntraU se4er � N��
�/�
Address W mort�age� w mntratl smer (nnmbar and stree4 �al: ffite. aM LP code)
Name of azsi9nee w oNer owner or taldu of mortgage ' "_ .__
AdEfess ot assiqnee (numDer ard atreel, ary, sfele, antl LP aode) �����)Q�
�v— •••••.....
Dces appli�ant awn property in any oNer If yes. what munty? Wh: � �• C� � O••••••••• n ptopelty
munry in InOena? ❑ No � l�:l\
❑ Yes 31 ��I �� .... o No
couNrrauor. C;�id��•.•��5,�1�j.�
Detluclion apywed in Ihe artpunl oF.
20 20 _ 20 20 20 _ 20 _ 20 _
Sigrature U Camh AuOitw Counry Da�e (monM, daY• Y��)
I/ We certify urder Ne penalty of perjury Nat the above and foregoing infortnation is We and correct arW Nat Ne applirant is a resident of Irdiana and
owner / mntraci buyer of Ne a(o2menlioned property un date applin4on is filed.
(oxne/5 fu0 name/1/� , — Date (rtmfh. daY. Yvar)
S- lll� _
' F7W�I resid atlNess ot appfxant (num0er and sLee4 tity, state, and ZIP mde)
.D l �//S.�CR,;vso S a— 4.�/ �'.- n/ UiG6 � .
Pe�sm au�Mr�d Dy dWy ezewcetl Power d AvorneY a M IC 61.1-72-0.7 Date (monlh, daY. Y��
Mtlmss of author'¢ed Cerson Inumbar aM sveet �'M state. and LP mtle) . . �