HomeMy WebLinkAboutMortgage_Hopperr}:'
�
"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co n ow ear
_. FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 93709 (Rit / 6-09)
� f PresaiDed by Departrt�eN o/ Lod GovemmerG Finarrx
� JU�F�i
wsrRUCnorrs:
Fortn Ned wtrh:
To be �led in person w by mail witfr the CountyAuditor or Counry Recnrder o7 the county wliere the property is located.
Fifing Dates: i) Real Properry: Must file during the yearlor which the deduction is sought ��y q�d�y�
2) Mo6de / Manufactured Homes rwt asseued as Real Property Must file dunrg the tweNe (12J months �' N
6efore MamJr 37 o/each year the deduction is soughG t'a1896N COU � Recorder
See reverse side /or additional instrucflons erM qualficafions. � �
rapny o�s �a � � icr
������
! i. Q11P1� yC8!
tl ro, whal is ha / Icer e�d share ot inten
tl furne m rem'tl o 6Ruent tlian Mat of �
Nartre of rtnrtgapee «mntracl seQer
naaress or mutv� , �,o-aa uue�
Nama of a4ignee or otiw ovmer or holde
Aderess of assignea (numbar arW saee4
Daes e�z-eN wm WuG�Y in a�ty dhn
countymWiana? ❑ Yes
DeEUCCOn apryoued in Cie amoura of.
�
Signature of CambNditw
�,co— � �— � —
Mortpage / ContraR intleb
lAamh 1. arterrc yra
�
. uiC'� Debw:
�— �G�i�O
MPBM M Oi MO
E9Ib or a
sarnearie
spouse.
propeny in Vuestion: MnuaOy Assessed
�I Pfoperty � MnuaOy A55essed
� l.v,�,/.4.r �-"`�,� 59,ao� �-
. `Ii "
7`/d. � H Has ths de0uctim Daen
' I—� W� for ament yeaR
20— � 2q— � 20— � 20
Counry
�
aer, r�A
m ptopeity
20
No
I/ We certify under the penalry of perjury that Ne above arW foregoing infwmation is true and correct ark Nat the applinnt is a resident of Indiana aM
owner / contraU buyer of Ne aforementioned property on date ap�'rotion is filed.
� i7%S///� me) � �� Data (montl�. OaY. Y��
( ,
F� I�r�tl" e addrass of appfuant (numbe�arf�1 street �ry, s+are. ard ZIP ootle) i,
tiP82s a1ESr �aar� oQ�l� c�r�. ��/ y�l�o --- --
Pasm autlwrved Oy ddy ezecuted Power W Ammcy or C�' IC 61.1-12-0.7 Data (monfA. QaY. Y��
i
d person (numDer and s�ee; dry, stala, antl ZIP mAe)