HomeMy WebLinkAboutMortgage_Stafford (2)I.t "'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou owns ', ar
FOR DEDUCTION FROM ASSESSED VALUATION ,
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File Mark
INSTRUCT70NS: `Yn �
To be filed in person or by mad with the CouMyAudHor d the county where the properly is bcated. O'�
Fding Dafes: 1) Real Property: During the 12 months belore June 17 0( the }rear the deduction is to be eNective. �TY AUDITOR
2) Mobile Homes assessed urMer IC 61.1-7: BeM�een January 15 and March 2 of the yeai Me deductior�b5�
See reverse side far add'rtional insWctions a�d qualificafions.
Aypirarrt (awner 6uyei'see rea
Tadrg Dis4ia . Key r
Assessed val teal poperty as aF MarU 1
If�hat is h's / her rxaG share aF inferesi
If reme m record is aif(erenl Uian Ihat oi ap
Name M rtrortqagee or coMraU sdler
-�ur—�
�9a9e / CarNxl
ainerrt year ^
indimte belav:
ot moR9� a conirad seller (number arM 9ree4 dA: sfate.
Name of assignee oI dtrer owna w holder W martga9e
Address of assigriee (rembe` aM strae4 rity� Aafe. aM7�P rr�rLe�
�ces aP{iicaM own 7��KY in arry dnar
couNy m Ind'anal
❑Yes ❑No
DeducUon apprwad in lhe amount
20
Signature af Countylwd�nr
�
od- DO/
� unpeid as o( March 1. r
oxned wAh sortimne alher Nan spouse.
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caunry
, ..�_I � �R�O
« equitaae owner,
❑Yes ❑No
Is Uie property in quesUm:
❑ Real Prvperty ❑ Modle hbme QC 61.1
����,
fd artent yeaR
20
�o��
❑Yes ❑No
Dale (month. EaY• Y�A
20
I I We certiTy under the penalty of perjury ihat 7ie above and foregoing infortnation is We and cortect and tlial fhe apptinnts was / were a resident of
Indiana and owner of fhe atwementioned property on March 1, 20
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of applicaM
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Power of Attomey w �y IC
oode)
.Fr
af aulhor¢ed per'.,an (nam6er aM streef, dty, sfate, aiM LIY mde) ._... .'. – .. . _ '