HomeMy WebLinkAboutMortgage_Wade.''� STAIEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
.. FOR DEDUCTION FROM ASSESSED VALUATION ,�
srme F�m as�a9 �ae i zo�>
S � Resv,bed br Depanme�u of Laca� Govemmem Firnnce
4N
File Mark
iNSrnucnoNS: APR 0 � 2009
To be filed in person w by mad witA Me CourrtyAuditor o1 the courrty where fhe p/operty is located.
Fd'arg Dates: f j Real Property: During the 12 months be/ore June 11 of the yrear the deduction is to be elfective.
2J Mo6�e Hortres assessed under IC 6-7.1 J: BeMeen January 15 and March 2 of Me yeai the deductim is to be
See reverse side for addibonal insWClions a� qualifications.
ApplicarM (owner or oontr�Squy/r}- see ra9r:cHu�s,qr�raverse si� � / � �
UA.LXT c�1 b'
sed rehre of rrai propetly as of
whal is his / her cmct share a
i' m retord is Cil(erml Nan U
; of mortgagae ot mMraU sdF
�T_^7
�
Page m�mbe,
1. a.min v�r Afortgasa � cowm jQ� u�T at nAarai 1. I �e Ihe app6rant u�e sae �ega� « equi�ac�y�o.vnen
wrrer0. year / j
��1 U/lU ❑Yes ❑ No
ot mortgagee ar conirea sellet (nwnber arrd strse4 aN. state, aM
Name of assignee a W�er owner m hdG
Address of assigrree (rum6er end sGeel,
Dces applicant wvn property in erry other
counly in Indiare9
❑Yes �No
OeduGion appioved in the arnount of:
wrt�eme ather Uun spouu,
ciry; 5ate. and L ,
i •
�fy Dra�r�er NO...°2.�%...:......
� �as a
Card NO. ........ .........
��'S,000.�—
pQi � p � �— � p— � 20—
Is the property in quesUm:
❑ Real Pmpeny ❑ Modle Home QC 61.
�s ths d
wRenl
20
�ao�a�v�r
❑Yes ❑ No
Dale (monlh. daY• Y��
20
I/ We certify under the penally of perjury ihat ihe above and foregoing information is trve and cortect and Giat tlie applicants was I were a resident of
I�ana and awner of fhe aforementimed property on March 7, 20
rw��.wrr,w�r✓� hn�wmef �. Da1e (manN. daY. Y��
�dd�al address of i{qlicanl (number and s6eet, aly, sfa(e, and ZIP cd
Pmson aulhar¢ed by tluly erzecuteC Power oi Attaney or by IC 61.1-12-.07
Addrrss of
strseL cdy. sfafe, antl LP mda)
day, yea�
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