HomeMy WebLinkAboutMortgage_Butcher (3)°*� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
s�a F«m a3�o9 (Re i Zv»
S / presaibed by Departmenl of Loral Gavemmenl Finance
N4
File Mark
iNSrnucnoNS: FEB 1 3 2009
To 6e filed in person or by mad with the CourrtyAuditor W the cou�y where fhe piopeAy is bcated.
Fd'o�g Dates: 1) Rea/ Pmperty: During Ure 12 rtronths betore June 71 W fhe year the deduction is to be e//ective.
2J Mobile Homes asseued'eMer !C 61.7-7: BeMcen January 75 and March 2 of the year the deduction is to 6e e. v
See reverse side fa additional instrucGOns aid qualifitations. ay .a�g
C/ C/
P.pplicamJqxx�ei g.frontrad 6uyer' see �gs�r6ctjq�.s m reverse sir{e) n / �
real popaly as d Mard� i,
is his / her e�ci share
I If name m
mortgagee or cmUact
— J —� �' " Uu'
� Y� �9e / CotNaC in�fe6U
arteM year n /
mongagee or m,uaa seller (ruunber ar,d �ee4
Nartre af assgriee or olher o+mer or holtler
Address of assignee (rember aM sbee{ di
Dae� applicarH own PopertY in arty other
courrty u� Indiana?
❑Yes ❑No
Dedudion app�oved in Ne amoun� of:
2b 20
Signature oi Counry Audrtor
belav:
�afe. and ZIP coee)
If yes, what
��1��
as or March 1, ` I Is ihe appficant Ihe sde legal a equitahle owrre/7
❑ Yes ❑ No
If wmed wilh mmeone olher Ihan spouse, hd'icate
20 � 20
[✓'��
Is Ihe property in question: _�
❑ R�I P_mo�^'�°'—� 6-1.
— ��..L
�O..Q..�.....
►7l':l\\'Cl" 1
�
C;�l.� \Q . ............
.........
„a.www� oeen requesled on poperty
fd curtent yeaR
❑Yes ❑No
20
Date (rmnN, tlay, yea�
20
I/ We certify under ihe penaity of perjury that the above and fwegoing infortnation is We and corteG and that fhe applicanis was / were a residenl of
rndiana and owner of the aforementioned propeAy on March 7, 2b
s..o a�„re nn.umel _ Da�e (month.OaY.Y�Q
XFuA residenl address af applicanl (num6ai aM s6e ray, sfafe, aM LP mde)
�35"3S-S-t•RdS :'l� ,c9;
Pamn aWlqrized by duly exeaAed Power of AtlaneY or by IC 6-1.1 7
Address ot aNhor¢ed person (numbei and streef, dy, sWte. a�M Z!P wtle)
Date (mmlh, day,