HomeMy WebLinkAboutMortgage_Shanks^'� STATEMENT OF MORTGAGE OR�1�T�1C� DNESS Coun Township Year
FOR DEDUCTION FROM ASSES3EDi7A'ttTA
' state Farm a37os �Rii ie-re) ULY ENTER D FOR TAXATI N
,,�,� ` P�esaibed by Department of Local GorertuneM Firence N 0 V 2 2 2011
$U �e i e Mark
�NSrRUCnoNS: C.�. _,dayof —
To 6e filed in F� �� ��
person w by mail with the Counry Auditor or Counry Recorder o/ fAe ere the prope ��{
Fil' Dates: 7 Real Pro Must file duri the ear (or which the de,�u ' �- J�
m9 ) Pa�N� �9 Y 'fOR CoJtt�iMdimr
2) Mo6ile /Manufactured Homes rrot essessed6A8t6��rb� unng the twefve (12) months ����w
before Ma2h 37 0/ each year the deduction is sought.
See reverse side /or addifional insLUCliuns arnl qualilmatrons_ PdTC¢� #
t ,f0x�Ier m confrdtl b Il see resnicti�rn�s m[{/9verse sde y�a' C L L
�/A/nl>nAM 7C �/- 1 T/nn. '/ C 1/)/�M A-�/�
Y tral FvopMiy as
Y�
of inte.�esi?
-3�,-h��3
If narre m �emN is diRerenl ihan Nat of appfifan; hMilate Gebv.:
Name of
��
��
unpaid as of Mortgage / ContraU'uWebtedness unpaiE as of Is Ihe epd�^� �e sole
date o( applxatian le9al or equltahle oxrt�el.+
❑ Yes ❑ No
If awrred wiM someone othu ihan spouse. mdrate wNh xinm
cG}; state. aM LP co0e)
(n�mcer am sueet �', smre. ana ur caae�
Dces applinnt own properry in any aher
muNY in IMiana? ❑ Y25
20
Sigrebue W
20
h tM property m puestion: MnuaOy Assesse0
�RealRoPeM ❑��!�Y�
Dra tirer- �\'p. ,
..ao��
Ifyes.whalmunt�/.+ Card �\'p. � ' • •.
;ea o„ v�r
�o,a�� Z���.�..... Y� ❑ No
f /i * � C�/ i� _
� COUNTYAUDROR
20 20 20
Counry
20
Date (morvh,
�
I I We certify ufWer ihe penalry of perjury that the above arW (oregoing infortnalion is true and cortect and that Ne applicant is a resident of I�iana aM
owner I contrad buyer ot the aforementionad property on date appllcabon is filed.
� wne/s�4A pmne) l i _ � Date (rtmfh. daY. YBaA
10 /U � L
Dy C�iY �ecvted
Pdtlress of auNa¢ed person (numberaritl snee4 crty. sfate,
Qete (rtronN. tlaY, Yza�