HomeMy WebLinkAboutMortgage_Harrod Development LLC"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
___ - FOR DEDUCTION FROM ASSESSED VALUATION
• . � Sfale Fartn 43709 (R77 / 609J
�,.,. 1 Presaibetl Oy DeparlmeM of Local GovemmeM Frmnce � g�
Y �
�'NSTRUCTIONS: g
To be filed in person w by mail with the CounryAUditor or Counry Recorder o/ tAe county where the property is loca
Fifirg Dates: 1� Real PropeRy: Must fde dunrg the year for whifh 7he deducfion is mught. A,�np (1
2) Mobde / Manulactured Homes rat assessed as Real Property Must file dun�i j'tM9 (wp� ZQJ�ianths
6efae Maich 37 ot each year the deduction is mught.
See 2verse side (or addifional instruclions arM quali�cations. C��� m"`.�—
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App(rant(ownerw r- restricti4As�^PYe���) _ n,A.,_. /�1 .�-.� �J
.�essed rd4c � real poperty as of
amh 1. aa�vV y .v
no, wha� a iris ! her eraa share o
/�o�al / i� V— V O� � . �.1 'lJ �J�7 Recad n0`�/�� P�� �O
�9a9e / traa indmtednass unpaid az W Morigage / ContraG'vWe6tedness un7� as of Is Ihe aP�t tice wle
ilarrh 1. tlate of app�ration legal or equita6le awrel�
�� O�l� ❑ Yes ❑ No
If ovmeC wiM someone oft�a than spo�se. ind¢ate Mith wMm
If name m �ecord is diRerent ihan itiat oi a0pfi�ant, mdinte bebw:
Name o( rmrtnaGeelx conVad seller
Address of nnrtgagee w wntraa seller �nvnber and shee4 uN. state. aM
Name o( assignee or other owner or MEg of mortgage
i
AOdress of assi9nce (number ernl svee4 �1: �e, aM
Dces appli.ant ovm property in any oNer I If yes. what munty.� I`ATaI Ta�d�g DisMct?
munry in InCiana?
❑ Yes ❑ No
— — —^OUNTYAUDROR
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Signawre o � .W.�. . . . . . Caunry
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ownerl�
Ifature ( y
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0 rz�itlem atldms W appGrant ( �
�s, %�o
rsan utho�¢ed Ey CWy executed
Wmss of author'¢etl person (num
state,
sL'ret dry. s+ata, antl LP mde)
15 C�e ProPenY in 9ue5UOn: Mnua�Y AtiSessed
❑ Rea� P'oaertv Q n�nua�yassessed
Has ihis tleCUflim been reQUested an property
ro, a,nen� r�� ❑ ves
❑ No
��:
Date (rtonth. Oay.
F��l
3 infortnation is true and cortect afM that Ne applirant is a resident of IrWiana and
3tlon is filed.
Date (morvh. daY. Y��
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