HomeMy WebLinkAboutMortgage_Gray (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_, : FOR DEDUCTION FROM ASSESSED VALUATION
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S,,,. � PresmbeE M��m or Lod Govemrtrent Fuance
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INSTRUCTIONS: �g
To be filed in person or by mail wifh the CountyAUditor or Counry Recorder of the county where fhe pmperty is bcated. A � 7���9
Filirg Dates: 7) Real Pmperty Must file dunng the year tor which the deduction is soughL Ly Counly AuditOr
2) Mobile /Manufactured Nomes not assessed as Real Property Must file dunng the fweNe (72) months
6efore March 37 0! each year the deduction is sought. ���Rb Re�e+
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Seereversasideforaddifion�stn�cli�wisarMqualifications � &�gSbi�yCnjI1JTV AII�ITOR
AppGrant (owner w r �Mraou q� re�xrse stl4T� I� n .
f vaNe of � qoperry as
arrent yrar
ra. wha� a his / trer e�1
nimber/ 1 escription ) ,^�
— � ( l� —O�
oRgape / Cont2a indehtedness unpaid as ot
Mamh 1. airtent yeer
If'ame m mmN a Citterent Nan ihaf W aDP�t iriGkate bebw
rlame a mwtgagee «conuaa seuer
Addrea of rtart9a9� or contraU seAer
w aNe1 owner rn halEer at nwtgage
Does epplica' �'-- ^^^^nv in anY oNV� I tl yes. what munt�/.�
mur4yinlMi —�'_ _
Dra�ver i\'0.....ca.C�C?.g. —
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Deda�°°^a Card No. . 3�r�
zo ���,(�33 � zo
I/ We certlfy ur�er the penafJy of
owner / contract buyer of tl�lafon
Siptatura (owrie/s e)
K
I ' nta fappGCant(numbe
C��(�/11, [
Person auNOitretl Oy�ecuLLd Po.v
ACtlrcss of auMOr'vEd person (num0era
of I Is Ne epplkant fhe 5de
legal w epuitade ownel+
❑ Yes ❑ No
tt awned vriN mmearie other than spouse. IMicata wtth whom
W�at Taung
zo
Is ihe property in puestion: MnuaDy Assessed
❑ Real Fvperty ❑ ArmualyAssessed
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ICaunq Date (montn,}�y� / O ��
Nat the and foregoing infortnalion is true and mrtect arM that ihe applipnt is a resident of IrMiana aM
ned pr erry on date applipaon is filed.
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State,
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