HomeMy WebLinkAboutMortgage_Alden'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun r
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
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S � Presoioea q Oev��� o� Loml Governmem France
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NSTRUCTIONS: v
Fwm t�ed with:
To be filed in person or by mail wiM the CountyAUditw or Counry Recorder of Ne co�nry where the pmperry is located.
Fdirg �ates: 7) Real PropeRy: Must 51e dunng fhe yearfor which the deducfion is sought. GI SO v�.:C��� q'jfd^�'TOR
2J Mobile / Manulacfured Homes rrot assessed as Real Property.� Must fi7e dunng the twelve (72J months
befora MarCh 37 oleacA year the deduction is sought ❑ County Recorder
See reverse side for additional instnictions and qualfications.
MP��� (qy�� or�nntract buyari' sge)estrictiwss m reNerse side)
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ed vah�e Ureal yaprny a
1, �� �
I( ro. what is ha / her eraf2 sl�ara of inte25t?
If name on remrtl is tliflerent Nan Ihat af appli�ant, ifMinte Oebw
sbee4 �Y. sfare.
Name of assi�ee or other owner or holder of mortgage
Mdmss o( assignee (nUmber and 5LEe4 �y. slate, aM ZIP cade)
�oes applimnt oxn yopdry in any oUier If yes, what county7
counryinlMiana? � . � _.
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sgren,re
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/ Reco�d �uunber Page number �
�debtedness unpaiE as of Is Ne ep�t tl�e sole
kgal w equitahle ovmeR
❑ Yes ❑ No
an spouse. indka[e ��iN whom
Is �he property in QuestiDn: MnuaOy Assessed
eal ProPertY ❑ Armually AssesSed
Mobile Hane fIC 61. t-7)
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Card NO. ���
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I/ We certi(y urWer Ne penalry of perjury Nat Ne above and faregoing in(wmalion is true and cortect aM lhat ihe applinnt is a residenl o( IfWiana aM
owner / conUad buyer of the afo2melrtioned pmperty on date application is filed.
FW Rsdem atldre,sIof apq/u'a�n�t (numDer a sf+eet/d�ty. sfate, and Z/IP m
��3i�- �.l l�/n✓(r�� 1 � �/)117�
P�..m autho�d �y CWy eaecutetl Power of Avomey w by IC 6t.1-12-0.7
person (num�er arM stree; U�; sfate,
reen
Date (monf�. daY. Ya�)