HomeMy WebLinkAboutMortgage_Jines (6)^�� STATEMENT OF MORTGAGE OR CONTRACT INDE
FOR DEDUCTION FROM ASSESSED VALUATION
Stafe Fwm 93109 (R71 / 6-09)
�' Presaibe0 q' OePa�rLL of Lacal Govertunenl Firmnce
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INSTRUCTIONS: ' �"
To 6e filed in person a by maii wifh the CounryAuditor or County Recorder o/ the county wlte2 (he property is located. �� �
Fitirg Dates: 7) Real Property: Must file dunng the year for which the detluction is soughG � nty Audimr
2) Mobde /ManuFaUUmd Hortms not assessed as Real Property: Must file dunng the tweNe (12) rtronths
6efae MarCh 31 of 9ach year the deduction is soughG R���
See reverse side (or additional insfixtlons arM qualifications.
- see �Snirtionj,pn re�xrse
P.sxssed vahie c( real
M�ch 1, artPfR year
i 11Q W�iLl6 �15 � h2! 8I2d 5�12fB Oi YI}PIPSl7
5
�i fIM18 Ofl R6IId 6 QliiPlPl111�13f1 I�IdI O� dp�('2III� �KdiB bC�O'N
�rtgagea «mntraG seue
mortgagce or convaU se
sionee w oNri owner w
Addrass ot astignee (number artl atreef, my. sfEte, and Z/P oode)
Oces eppluant rn�n praperty in any other I( yes, what
munryinlMiana? � �
aM
� i a� , '
� � Tr i�i -i v �J o �o
unpaid as of Mwtgage I Contracl iMe6tedness unpaid as of Is Ne eppl'aant Me sde
date of app�cation kgal p equitade o�mll
❑ Yes ❑ No
If owneO wdh mmeone otheJ than sPO�. IMkate rith x4nm
Is Ihe P�GertY in VueStiM: MfwaAy Assesud
� Real PfOPeKY ❑ ?�!���Y �
sted at pmpPny
Yes ❑ No
COUNTYAUDROR
DeducAOn appiwed in tl�e airount ot
20 20 20 20 20 20 20
Sig�anrte d Camb AudRor Counry Date (rtanfi, daY. Y��
I I certify under the penalty of perjury Nat the above and foregoing infortnalion is W e and cortec[ and ihat Me applirant is a resident of Indiana arM
r! mntracl buyer of the aforementloned property on date applicalion is filed.
Sig re(own' � hAreme) ' Date (mavh. daY• Yea�
i
lrcsident olappf ( m r ntlsLee4 � fe.and fPaotla)
P auttptrseE by OWy exewtetl Power of Httomey w by IC 61.1-72-0.7 Date (ma+fh. day, yae�
PCdress ot aWqi¢eE person (numbet arM sbeet �: sbta, an0 ZIP oode) .