HomeMy WebLinkAboutMortgage_Gray (5)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
:_ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sla[e Farm 43709 (R11 / 6-09)
,' � Presviced by DepartmeM of Local Govemment Fnence
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INSTRUCTIONS: wrtp
To be �led in person w by mail with the CountyAurliror or Counry Recorder of fhe county where the piopeAy is located. M�� p 2 � � �
Fi7ng Dates: 1) Real Property: Must file durng Ihe }rear for which Ne deductiar is soughG Counry Auditor
2) MobBe / Manu/actured hbmes rat assessed as Real PrtipeRy Must file dutig the hveNe (12) months n
before Ma/ch 37 ot eacli year the deduciion is sought. �-, L �f�'��d�
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See reverse side for add'tiona/ inswctfons erM qualifications � � R
Ava�}SOyrelorovvraabuyar-seerestgeq�smreversesiie) �^IB50;� u ' • .
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�a rah�e a real ryoprny as a
1. anent ytar
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a -yi - io3 -aao. s89-
Abrtpape/ Contract 4itlebte0ness unpaid az N Mortgage / Con�act iM
Mamh i. wfrent yeg� D date W aPP��
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rc o�ee wn, ��,eo� � w�
��t maicate Celaw � .
�����«�,��e, /� Dra�ver�NO....�.�..........
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Address of rt�ortga9ce m m�vaU sWer (nunbel /�// �
C�I'd \�... ..:. � �! i�....,.......
Name ot assignee v othei owner w hddu N m _. ' .
AdCrmso/assigrree(num6areMStreeC�Y. - ,.�-;.� -' .
� I '.t —d 3.d'� C
Ooes e�ipr�[ am perty in any wher I( yes. what munry.+ What Taang Distrifl7
munry m IMana?
n Yes ❑ No
Rem�d number
I legal «eduitade o�.+ren
❑ Yes ❑ No
sva+sa. 4�dtcate witl� vrtiom
Is Ne praperty in Questian: Mnuelly A55es5eE
G1R�a�aertr ❑!w�Na�a
N's deAud'nn Deen reGUested m pmputy
unent Y�r r-� .. r't
COUNTYAUDROR
duman app�weC In Ne amounl aY.
2p _ 20 _ 20 _ 20 _ 20 _ 20 _ ZO _
�naLrte of ry Auditor ^ Couny Date (monM. daY Y��
�J
1 I We cerbfy urWer Ne pen of perjury that Ne a antl foregoing infom�alion is We and cortect arM that Ne appliranl is a resideM of IMiana and
owner I contraa buyer ot t afoiemerttioned prope on date application is filed.
�ranuelownaf6luHreme) �l _ Date(rtmfh.daY.YmeA
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aM ZIP ootle)
persm (num6er aM sbee; dry. sfate. arM LP aotle)
r � Date (rnw�lh. tlay Yse�