HomeMy WebLinkAboutMortgage_Hartn STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
FOR DEDUCTION FROM ASSESSED VALUATION
sa�e Fam as�oe (Rn i e-w> �
, w,. Presvieea ey Depmvnem at �om Gwemmem Firer�e
d
INSTRUCTIONS: q�.w�
To be filed in person or by mail wifh the CountyAuditor os Counry Recorder of tAe counry whela !he property is located. S E F� y L U I �
Fifig Oates: 7) Real Property: Must �ile during Ne year (or which the deduction is soighG � Counry Auditor
2) Mo6de / Manulactu2d Homes rat assessed as Real Properry: Must file dunng Me M1velve (12) months � µ n�unry Recorder �
6efae March 37 0/ each yEar the deducfion is saqht. 4-
See raverse side 7�dtlitional nst�uctions anq q{�alficatbns. , U
�. ��
� �,
�
�o� q�b Page wmCa
�--/%.3� �R�-o0ti• �y'�-o09 � l<i
,�,� ���� �,����,���, ������
vrtem /�� /� date ot aPp�tbn kg� a M�� �
v v ❑ Yes ❑ No
��o��,� n��,�,�,��,���.��,�„�,
mere�� w� m� or aoW�+�. �,a�m ceiow �� me a�a�r �o a��,: a„�oy naessea
❑ R� r�naenv ❑ ?±,!�y a�d
rlame of rtrr�ea «cm,o-arl seuer
ACdress d rtiorya9ee or mntraG se�
rlan,e or as�ee or oNc ow�a or r
C .
oces app�nt v«n pmperty m eny?�
munry in Intliarria? i
❑ YB 1.
� O• �••
i �i(• ^ . �
Detluc�on apao�ad In tha i ^—
0: l, 7.
r- ✓ � _
coUe)
counrr
Tad�g Distri�Y7 Has Nis deducmn Eeen reQUeste� m 7�Y
far a�+ent YraR ❑ Yes ❑ No
�
20 _ 1G� .' r'1� _ 20 _ 20 _ 20 20 _
/��,./
y9 py� / . ^` `O ��" ` Counry Date (monM. . �lj /�
� � 7—
�
1/ We cert�`y . �� at the above and foregoing informaGon is We and cortect arM ihat Ne applirant is a resident of Indiana aM
owner / contract . �e�r°p4jry on date appiiption is filed. _
ci,.,,�.,�.d r,.�.�.,ek ndUa.. Date (monfh. deY.Y��
la�d� t(�i�rMStree(�y,sYdte.a .(//J���� -/—� �!-b�!
/Ji
��
wrt�tl Dy dWj euecuted Power ot AttomeY or by �C 61.1-12-0.7
of autlmr'ved ce� (numberantl sbeeG �: sfate. end LP mde) .
Y�eA