HomeMy WebLinkAboutMortgage_Hight"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
, ; FOR DEDUCTION FROM ASSESSED VALUATION
: — S�e�,����R,,,�� gvED
�,.,. � Prcwibed by Departmenl af Loral Gavemmenl Fra� B�
i File Mark
wsrRUCnorrs:
Farm t�ed wiih:
To be filed in person or by maii wi(h the CounryAUdito� or Counry Recqrp�r, oE{li@ ��j ivhere the property is located.
Fi/irg Dates: 1) Real Pmperry: Musl file during the year for which thelC�8uc6br�s �dlAjbL Couniy Audimr
2J Mo6de /ManufacNred Homes rrot assessed as Real Property: Must fiie dunng Me twelve (72) months
before MarcA 37 ofeach year the Ceduction is sougfL,`J,ry\� ❑ Counry Recwder
See 2verse side for eddJwn01 instrucUons.and quali�cations. ,.
Ass�ssl ydue oF real poper:y at
�latli 7• aara�t year
II ro, what is his ! her erarl share ot
narne on temrE is difteren� Nan Mat ol applicant, indicate below.
a contiaU se4er
.,'� . i�?^��'ri�r :i
Name ol assignee a othel aw�m1 w Imldal of mortgage
Y�
—vl.G� WeZ–CN7 v Remrd�wrtpe� FageQ_I ��
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�n� az of Mwigage I ContreU iMebieCnrss unpaid as ot Is ihe applirant Ne sole
Eate of aDV�tia� legal w eWitade ovmeY7
❑ Yes ❑ No
If ovmeE wiih someorre other ihan spouse. iMicate uiN wtrom
AANess o� assgnea (num�+^• -�
Doe` \
mun 0... �O,t\.. • • "..
= pra��'�i � _
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Deaua � •••••••.•.••..
— C��d�O`b'��.1�
zo i zo za
I I We cerlify untlu Ne penalry of perjury N�ihe above and (ore
owner I contraa buyer of the aforementioned pmperty on dat�,
f^ re�/u�n2me) u/i LL�W , H/�
�Full ' ent atldress of /ajpp�Gnnt (nu�mIDer an�tl.stlree4 m1: slate a( d Z!(P o�d
�{�i r l�{� f A,fGI� e� /�.J IoSt6.[
P�..on auNO�aeE Dy O�dy ezewted Power of Atlorney w Cy IC 61.1-12-0.7
AACre55 ot authwvEd person (number arnd srvee( dty, 5tdte, aM LP tade)
NTa� Taring Disfricl?
�z��
Is Ne property in v��+�: A^�ally Assessed
❑ Real RoPe�N ❑ ��N�
Has Nis tletludion Oeen requeSteA m prt�pP.rty
(or turtent yea(?
❑ Yes ❑ No
�— I �
infortnation is We and cortect aM that Me applirant is a resident of Indiana arW
ion is filed.
Da[e (nmfi, day, ysa�
Date (nmN. tlaY Y��
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