HomeMy WebLinkAboutMortgage_Weiss (4)'° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS s Year
__ FOR DEDUCTION FROM ASSESSED VALUATION �
- Sfate Fwm 93709 (R71 / 6-09)
�' ,�,. aresaibed bv �� � tnd Govemmerrt Flnance
File Ma�
lNSTRUCTIONS: OCT ��
To be ned in rson w b mail with Ure Coun Audifw or Coun Recorder o! the coun where tl�e io F� ���
Pe Y b b b P PeM is bcatsd.
FiNng Dates: f) Real Property: Must file durirg fhe yrearlor which Ne tleduclion is sough[ �� nty Auditor
2J Mobde / Manufactu/ed Homes not assessed as Real Prt�perty Must fiie dunng the nveNe (12) rtanths9 �!
be/we MarcA 31 of each year the deduclion is saght. � ^tY R��
See ieverse sida !or adtli6onal insWCtions aM qualifications. GBSON C'
' App�tam (oxTe! or NntraC bypef - seb rasbifSOns m r►versa�sida)
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A� rahie d mal pioperty es d A1c
MarC11.aRtlGY� Me
❑ ro. xiiat 6 tYS / hu azxl shere M interest?
-�� - �o3-oaa. /'73�00 9 �.o_ 3�%$
/ Confrati'udnbteEnero un0ab as W MMgage / ConYaU u�0ebteCness �mV� as of Is Ihe eppfirant tlfa sak
vrtmt Y� 7� dam 01 appfi�t6n �gal or epui�aGe ownnll
7� �D V ❑Yes ❑ No
If wmeE wiN sommne other than spouse. 4Wicate with w�om
tl nartre on recoN o dAferent fhan Na[ ol app0onl, trMi�ate Eelaxc
Name at rtiortga9ee or rnritraa s�
AOd�ess d rtiartgagee m m�traa
cdy, uate. aM LP mde)
Name of assi��ee or oNer wmet or holder d rtrtrigage
AEC2ss W assegnee (num6e�� ntl saeet �}: sqfa. end LP mAe)
DoeS e�ipnt own popeM1y in eiry otl�jt
munty n Ind'ana9 r
❑ Yes l
Deduabn apWa'aE b Ihe amourv af:
�_ �
� I/ We certify urWer �/e pena
owner I contraa buyer of Ne
' / (ownerS M )
/\
W msidem W t i
io
Person awa�e cr auh �QU,Na
-a /_
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WhatTarir
COUNTYAUOROR
zo � zo _
Caunry
Iry of perjury�at the aDOVe aM foregoing mfortnaUon is true
a(o2mentioned property on date appiicaGOn is filed.
puson fnumberaM svee4 �: s+sfe. end ZIP mde)
J
peM1y in Vuestion: MmiaOy As.essed
Roaenr ❑/vmual�'a�ssed
Nas Ma detlurrion Ecen reques0ed m propvty
kr a�rent Y�' ❑ Yes ❑ I
Dra�ver NO.....�Dlb
ca��a �io. ....... 31 I � �
� 13��115 ....
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