HomeMy WebLinkAboutMortgage_Adamson (6)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ s FOR DEDUCTION FROM ASSESSED VALUATION
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S 1 pryy�p�y yY pe��M of Local Gavemrtrent France p
� � File Mark
INSTRUCTIONS: �n�1
To be filed in person or by mail with the CountyAud'ROr or Counry Recorder o/ the (M��e�ryperty is located. F� �� �
Fi7mg Dates: 7) Real Property: Must file dunng fhe year for which the deduclion is s�Y unry Aueitw
2) Mo6�7e / ManufaUUred Homes nof assessed as Real Property Must file dunrglAB� fwelve (12) months
befae March 31 of each year the deduction is sought C�'��n `"''�'C'`�� ❑ Counry Recorder
v �
See reverse side (or ad�o al,inshuctions and q�a(�fications. _, T,�Q
1, ament ym
If tw, what c his / hef erxt Share of interest?
It name on rem(d is 6ltemnt than that oi app6Cant, uW'vate belmr.
«�
az
/'�O I date
C/
as d Is Ihe app4ant ihe sole
legal or epuNahle oxnM
❑ Yes ❑ No
If ovmed with someorre ochar Nan spouse, iMicate wM whom
Pdd2ss of rnMryagce or cmtract se0er (n�mbrJ aM stree4 �y: s+ate, arM ZIP code)
u-� !
- a�.i�.......
Dl'a\�'Cl" \�.....• �e
\ O . . ����• • • . what munry? VJhat Tavn
C��.� .......... \
�3 � 5�. c�
GOUNTYAUDROR
_...,...� approved'm 1he amount ot
I�
Si9riaNre
I/ We certify under the
owner / mntract buyer
20 � 20 _ � 20 _ � 20 _
Is ihe poperty in Vur.,OOn: MnuaM Assessed
❑R��ro O�N�
Has �his deduGion 6een reQUested on pioperty
mr an.em yean
❑ Yes ❑ No
20 _ � 20
Counry Date(manlh,�yead� �/
C7
!y oi perjury Mat above arW foregoing in wmatlon is true and wrtect and Nat the appiirant is a resident o( Intliana arW
aforemeMioned property on date appli ti is filetl.
�� � Date (monN, day, yea�
tlty, stata, antl
AEtlress of auNOrrseC person (number aiM sLee{ rjy, state, antl ZIP aotle) _ I
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