HomeMy WebLinkAboutMortgage_Johnson (29)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear y
_ = FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 93709 (R11 / 6-09)
�` � Presoibetl Ey �epartment af Loml GovemmeM Finance
e a
INSTRUCTIONS:
To be filed in person or by mail with Ne County Auditor or Counry RecoNer o/ the county where the property is located. F� �� ��
Fifig Dates: 1) Real Property: Must file during Ne year for which the deduclion is soughG ������i��
2) Mo6de / Manutactured Hortres rrot assessed as Real Propeny Mus! file dunng the tweHe (72) months �t�I
be(ore March 31 of each year fhe deduction is sought. CLy, Recordu
See 2verse side lw additional instructions and qualfications.
' " -o� - a�o _ 000.
ed rahie d real VopertY as d ' Mort9a9e / Contrati indnbtedness unpaid as d
1. qamE ytlr MetU 7, atRnt yeer
�f ro. whal fs ha I her eYart share Ot interest?
It name m�emrd a 6Re`rnt Nan thaf ol app�rant.
Name W rtwrtgagee or conaact
oNer ovmer or hoWer M mortyage
bebw
uN,
Pd7�ess ot assgnee (num6er antl atraet rdy, sram. ad LP mtle)
�H —�oN���, �o/� �
DeEU< d0"— (Q SLc
Z\"
Sigriature d Camb AuEimr
code)
liemra numb�i 1' wm
� - � �a// �
ngage I Contracl udehtedness unpeid as d Is Ne epd�� ��e
eo(a �( �i��
PPIrcaUOn O./.I/ �C,.�( 1 �❑ Yes ❑ No
tt wmed vrith someorre other Man
:OUNTY AUDROR
20 _ � 20
Coumy
uiN xi�o�n
ie ProPertY in questim: Annua9Y Asse�.ed
Res� Proaem ❑ nm,ua�y assess�
ror ameot yean
� N
���
Yes ❑ No
Da�e (nmfi. CaY. Y��)
r:�7
I/ We certify under ihe penalry of perjury Nat the aDOVe arM foregoing infortnalion is W e and correcl and that the appliran[ is a resident of Indiana aM
o.mer I contract buyer ot the atorementioned property on date application is filed.
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by IC G7.
Pddress of aWfor'¢Ed person (numbcr artl sOee( Uy, stat&
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