HomeMy WebLinkAboutMortgage_Ross (3)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ship Year
� FOR DEDUCTION FROM ASSESSED VALUATION
, Slala Fwm d3709 (R11 / 609) �
�' % Presaibed by DepMmer4 of Lad Gv+ernment Fiiw¢e
File Mark
INSTRUCTIONS: �
To be lded in person or by mail with Me CountyAuditor o� Counry Rewrder of the counry where tAe pmperty is !� �"� �� �'�
Filirg Dates: f) Real Property: Must file during the year for which the deUUCtion is mughG � �ry Counry Auditw
2) Mobr7e / Manufactured Homes rat assessed as Real Property Musf file dunig the fweNe (72) r(erRp3�`O"
6efore March 37 0! each year the deduction is sought. `T�"lY R�Ob�
See reverse side !or additional instructions and qvalifications. CpUN
�App(uanl(owner�contra r-seerastrictioremre vtle)
���, a- ��,, ��
rTe�]?D�st9� . KeY rvm0er / kgal dawiplion � Remrd number Pape num6rl
p'aperty as of
OYdtl Sh9f8 0( VIS2f25(?
/ ' C.V W../ V� i
oRgage/ Contraa inOe6tedness unpaid as Mortgage / CanSaG mdebtedness unpaid az d Is Ne applkant Me sde
MMard� 1. airrem date of aPP��+ k�l w eWttade oMneR
��J ❑ Yw ❑ No
If wmed with wmeone aher than spouse. mdirete wNh whorn
1f'ume m �ecor0 e SMuent Nan �hat of appGCant, "u�tlicate Celaw:
.r_.cr.—__-�
u�; smre. ar�a z .
owner or hdaer of mortgaya
ot a:sg�eB �numcer am suee4 �1: sm[e. ana ur cwe�
po¢s eppluant own property in any a
munty m Ind�ena?
❑ Yes
De�uctian appmved in tlie amount af:
20 20
Sig�aWre d Counh Autlitor
PmPenY �ArmuallyP55essed
n� rw� nc �i.
Drawer NO..�QQ.�.......
Card NO. ....�OoZrl''�.......
�'l�;000•°= :
'O{ � `"'� COUNTYAUDROR (p. � Z� 7 X
`_�
20 20 20 20
Counry I D
n Oeen requesleE m poperry
❑ Ye5 ❑
20
I/ We certify u�u the penalry of "ury that the above and foregoing infortnalion is We and cortect afM fhat ihe applipnt is a resident of IrWiana ard
amer I contrati buyer of the ntioned P�KY � date aP���n is filed.
��awre (0 1 Date (mw+fi� deY• YBaA
�
p resitlent address5�ya�nt (num6er and shaeL stata, and LP )
` '93N i OC Q�2l�cu� �'�`1 7— �{7(��O
rson auttptaed Cy dldy Gtecvted Pov.4r of Mort�eY w Cy IC 67.1-12-0.7 Date (/ronN, dey. YEa�
person (number arM sheot, ciry, slata. end ZIP cotle)