HomeMy WebLinkAboutMortgage_Meny (6)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
:.-_--..
; FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709IR71 / 6-09)
�' w° PresaibeA Cy DePartmerG of local GovemmeM Frence
�INSTRUCTIONS: n
To be filed in person or by mail with the CounryAUditor or Counry Recorder o/ the counry where the pmperty is bc�p 3
Filmg Dates: 7) Real Pmperty: Must �le durirg the yaar /or which the deduction is saught.
2) Mo6ile / Manufactured Homes rat assessed as Real Properry: Must file dunng the tweNe (12) months� �,.�
before March 37 of each year Ne deduction is sought.
See reverse side (or additional instnxlions arM quali�cafions. �
AppGranl (¢�a6f or WotrdC bu�yc� � /Q m reverse siie) _ � �
G �. /( / /{ L )
CJ �..LC. i� < JF�(J � vyc�itdLi
qTad'ng Districl
/�lLbc�it-Lt.�
P.ssessed rahe of real popgty as
MaRh 1. aarrnt ye.ar
If ro. what a ha! tcer erafl share
I( f121I12 M lBCOId 4 aflPfC11� Uld!
CounryAUdimr
County Remrdu
Key ndfnber / legal EescriDrion O q¢�b n�mDer Page nou`"�
oZ/o' -.i D�% - OoO, ��8 -Od Q p O
N Mm�qage / Contraa indrbtedr�s unpaA az U A/origage I Contraa'vNebtedness unpaid as d Is Ihe appGant tlu sde
Mam7� 7, a�rtent year date of ap /� legal w eputtable avmeYt
�P OO Q ❑ Yes ❑ No
Oi III�CRSi� II01MCd NtN ShcIP�1fE M12! CNI150WSQ. IIWIp1C W1N W�1lYII
Nat of aOP��l mdinre bebM'. Is Me p�operry in 9uesaon: MnuaAY Asscssed
❑ Rea� a�oaenv ❑ nr�,�y assessed
Name of rtrongagee or mntrar2 seller C R
/ J. F/.
AdA2ss ot rtnrtgagee or contrad sWer (num6er and sbeet c, te, aM ZIP cade)
Name of assigiee w aher owner or hdder of mortgage
AdCress ot assgnee (number and svee4 �Y. slate. and Z/P tode)
Does app6nnl own property in any oNer I If yes, what munNM what Tav�g Ostri�
munry in IMena?
❑ Yes ❑ No
D���„��� �o..��a........
C 8 I"(1 \ 0. . . I . ti-t� . . . . . . . . . . .
Yes LJ No
COUNTYAUDROR
Or�uction apprwed in ihe amoun[ of:
20 20 20 20 20 2(1 _ 20 _
Signaqne_o(COUnNnWitor � Counb Date(nro�vr.daYY'��)
C
I I We cenify uMer Ne penalry �ury that ve aM fwegoing informalirn is We and cortec! and Nat Ne appli�ant is a resident of Irdiana aM
owner I contract buyer of Ne atwemendoned erty on date application is filed.
\ I sigy;are (a,�,� r�a oate prio�m. dar. raen
x ��
� Full 2sident addres of applican[ (numGer and sbee dry, te, aM ZI e)
o/ N (r,/e - Sf � �fl �i%6? ,
Person auUwraeE Gy duy ezecureG Power o( AII�rt�eY a�' IC 1.1-12 .7 Date (month. day, ysa�
Pdtlress of auUror¢ed person (num0er aiM street �: state. an0 ZIP cotle)