HomeMy WebLinkAboutMortgage_Bane"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ship Year
: ,_ FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 93709 (R71 / 6-09)
S w. � Presaibe0 M�P��nl of Local Govemmerit Firence
File Mark
wsrnucnoNS:
F ed
To be filed in person or by mail with the CounryAuditor or Counry RecnNer of the counry whe2 the poperty is located.
FiliMg Dafes: 7) Real Property: Must fde dunig fhe yrear for which the deducfion is soughL Counry Auditnr
2) Mo6Re / Manu/actuied Homes irof assessed as Real Plopelfy Must file during the fweNe (12J months /f,F�
bePore March 37 0/ each year the deduction is sought. ��°Q^h'�def
v
See iever6 - e!or addi[iona/ insWcUons and au2lifit�ations. � G IB �
7, cmnt yPar
If ro. whet ¢ his I her erart sl�are ot intemst4
M name m �ecad is Eirterest Ihan thal U aPP��t'cMipte bebvr.
nartgagee or contract
mntraa seller (number end sbeeG
Name a1 assignea w othnl owner or twlder ot mMga9e
(number aM avee{ dly. s7ate. aM
Dces eppliraM ovm poperty in any o
munryinlnd:^...•a---___-- _
a� �
,ess u�pam as or
i�
? .3� �-tbCl (d-XJ'� G
Mortgage / Contraa indebtedness unpaid as of Is Ne
data o( appGCation kgal �
arN LP cade)
unty7 WlatTedrg DistrcY7
n���„���-.o...a �o`�......
zo Card NO. ...y�?.)�'..........
� � ��, poo .
:ouNn auorroa
zo _ zo
Councy
��
Yes LI No
Is ihe property in Quesron: MnuaM Pssesse0
❑ Real Roperty ❑ Armually Assessed
btobile Home OC 6
s Nis tletlut]im baen fepuested on Ort�pelty
artent Y�n r-� .. r-�
p_ � �_
day, y�r�
I I We certify under Ihe penalty of perjury Nat the above and foregoing infortnation is We and correU and Nat the apP���nt is a resident of Indiana arW
owner 1 contract buyer of the aforementioned D�PenY on date appliption is filed.
antlsLeet
authoraed Gy dWy esecuted Pax�N W Attomey or b�
per:m (num6el and sbee4 dN. sfate. and LP cotle)
Date (mavtlh.