HomeMy WebLinkAboutMortgage_Hornby^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
__ : FOR DEDUCTION FROM ASSESSED VALUATION
• Sfala Form 93709 (R71 / fi09)
S / PresaibeC by DeP��M af Loml Govemment Ftance
�� � 'le Mark
NSTRUCTIONS:
To 6e filed in person or by maii wiN the CounlyAuditw or Counry Recorder o! the oounry where the pioperty is bcat F ��
Filirg Dates: 1J Real Property Must file dunrg fhe yearlor which the deduction is soughf. ���
2J Mo6de / Manulactured Homes rwt asseued as Real Property Must file dunng the fweNe (72) months
before March 31 of each year the deduction is sought. D C� SjQY ry R��
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See reverse side /or additional instructions and qual�wfions.
r� n
MP�nt (ow,rer oroontrav buyer; see m_cvirlions op 2`e+se sife) -..... ,•,-„n�y
Tawg
M&ch 1. tlmnl year
11 ro. what is his / her exad shara ol interest?
It name on reond'a dfi�t Nan Na� of appBcant uN'uate belw!
frot�ayee «
u o�er owner or holder of mortgage
A7tlress
Does apptkant wm poperty in any oNer
counry in IMiaru? � _ .
� I �
i/ We certify urWer ihe penalty of
owner / contract buyer of Ne afw
Sig (owneh hAl name)
x
u retitlent atltlress pplinnt (nu
y�3 � �:
Person auUro�aeA Ey dWy ezecuted Pow
Address of auHiiarrzed person (number a
�:re,
antl ZIP ootle)
�
If yes, what
�
—/0.'� - 000.
���s ��wam � w nwn
��
Is Ne appE�t the sde
legal w eQUitatle mnml.�
❑ Yes ❑ No
If wned with someone other Tan 5pou5e. rtMiU�a �•:�` _�—
_—_ ____
:o�J...::.....
Dra���er NO.�T
. ��W .....
C�C(1 \� . ............�.
. � I I`i, r1,$0: - � —
GI�III: i� IS�I�I I L�7:7
zo _ � zo
Caunry
aeaoa,on eee� rec��a on v�r
��n ❑ No
❑ Yes
zo zo
o� ��nn. ear. r��
aM foregoing infortnalion is We and cortect arM that Me apP���nt is a resident of IrMiana aM
n date apPliration is filed.
Date (month, day, ysa�
shcet, city, slate, aM ZIP cotle)
a����,.
sneet. dry. stafe,