HomeMy WebLinkAboutMortgage_Elpers'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
:._—.
: FOR DEDUCTION FROM ASSESSED VALUATION
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ti � PreSaiDed by Oepartmenl af Local Govemment firexa
�STRUCTIONS: �
70 6e filed in person w by mad with Ihe Co�nryAuditor or Counry Recorder of the oounry where the properfy �s located.
Fi7ing Oates: 1) Real Property: Must hle dunng Ne year /w which the deduction is sought � F
2) Mobi/e / Manulactured Homes rat assessed as Real Pmperty Musf file dunng the twelve (12) months
6etore March 31 of each year the deduction is sougAL C
See reverse siAe for addifional instruclions and qualifications. 1
Pyp6r�y(oxnerarcontraabuyar-searestrirlionsmrevrrsesidej r7 ��6N
Distrcl
asNyty Auditor
..CounN Recorder
A
yza-e� otlo - b' - 3 _�l o F- o �o . o y o-cx� �' O�t / a 3 2-
Y mal pioperty as d Mwtgage / Contraa'uWebteOrress unpaitl as af Mortgaqe I Contrxt'vdeMedness unpaE a d h Ne aPpfrant tlre sde
yrar Mamh 1, wrtent year date o( appG[ation kgal or epuRable ohneR
3 00� ❑ Yes ❑ No
I her e�a shara of internst? If owneA vnN someorie oNer than spouse, i�Wkate wi�h wtwm'
It name on mcoN is E'ifremnt Nan Ihat
Name oi mwc9agee or crntract seUer
Address d rtvtgagee w mntraa se�er
S
w dher awner or MWer of mortgage
aMS�eet �: s+ate, antl.
�/__ �_
DoeS applifant oxn ynperty in any oUUer
wun�y in InEaria?
❑ Yes ❑ No
Deauclion approved'm tlm amount of.
ray, state, eM LP code)
Zo , � , �_
sy�c� w
Is the properry in Question: MnuaM Pssesud
[gReal Property ❑ MrnWh�Assrssed
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' VJhal Tari^9 Disiri� ��/ '� � ^''^ "/ J �
Ac.� �.
COUNTYAUDROR
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Caunry
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Date (rmvh. tlaY. Y��1
I I We certify uMer ihe penalry of pNijury Mat ihe aq6ve anC foregoing infortnation is true antl cortect arW Nat ihe appiinnt is a resident of IrWiana aM
owner I contract buyer of ihe afwementioned property on date appliralion is filed.
Signatu�re (�o)wnerE IWI n�ame-{)� l.� Date (rtvvh. daY. Y��)
uC�lir�.2/ OC • C-�
stata, a�d 21P catle)
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a
PdEress of author¢eC person (number aiM sbae4 �'. sYdfc, aM ZIP mde)
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