HomeMy WebLinkAboutMortgage_Jost (4)^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_,_ - FOR DEDUCTION FROM ASSESSED VALUATION
• Sta[e Farm 43709 (R71 / 609)
�' .w � Presaibetl q' �ePartmeiri IN Laal Govemmem Frunce
lNSTRUCTIONS: n
To be filed in person a by maii with fhe CounryAuditor or Counry Recorder o/ Ne po�nty wf:ere [I�e property is bcateN.E � ���'
Ftiing Dates: f) Real Property: Must file during fhe year /or which tha deduction is sought � Counry Auditnr
2) Mo6de / Manufactumd Homes rrot assessed as Real Prt�peerty Must file durirg the twelve (12) months ff--77
befo2 March 31 of each year the deduction rs soujjht ��� '�� Counry Recorder
See reverse side /or additional inshuctions arid qualifications. � ��� v
IMW�m�tsownerarmnva(tbu�er-seemstnctioncmfeversesYfe) � .. . .. ..
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Marrh 1. a+rbG year
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If narrie m remrtl is eirterent Run ihat M aDp�am.'uMirate helovr.
Name of rtwrtgagee n rvntrarl seDer ^/ �
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Addrea d morlga9ee or contraU seAer (n and sn
Name ot assignee or oiher owner a hddu ot rt�ortgage
p _ Da [�- .�- O O
aa �,deccea�ess unpaa as m Mortgage / ConV�af1 i
year date of appOCation
,Oa
stete. arrd LP code)
Mtl of assignce (numbar and aacef, fdy, sfete, and LP cotle)
�? SF 36-3-II Co5 AL
Does apptka_nt ovm qoperty in any oNU If yes. what counp?
munty in �n0ena? f'"l .,_ _ i-1 .._
20 I 20
RetorO numCer Page numOpi
2�0/ (o/7G
un0ai0 as d 61he ePW�t the sde
legal w equita6le axfreYl
❑ Yes ❑ No
Ii owned with someone dher Ihan spouse. IMka[e with wlnm
�Ist(pe propeJry in OuesDOn: MnueOy Assessed
Id,J Real ProqenY� ❑ !4nwalil! Assessed
J �Si', i�7e.,e� � _ _
�1W%� �
ao,v-�i�G �� ,s�� �
COUNTY AUDROR
20 20 _ 20 _
Counry
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� � oate (mm�h. dav r�A
24
I I I We cerlify uM�f the penalty of perjuq%that Ne above and foregoing information is W e and cortect arM that Me applinnt is a resident of I�iana aM
owner I mntract buyer of the aforeme�Oned property date applicatlon is filed.
Signan�re rYMI ) Date (montl�, daY. !'a�)
Full resid t address U appfranl umDer a sLeef. crt}; atate. erd ZI mtle) /�� /�� ���� �
�n� .S i,��P�� sf 1�,��s`o �_
��, aw,o�a oy ewr �ea,;ea ea.� oi a'u„eY m nr ic �,.,-,z-0.� ° oa�e (mo�rn, ear. r�n
Adtlress of aNhorrzed person (num6er antl s0ee( Wy, state,