HomeMy WebLinkAboutMortgage_Bittner (8)�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 93709 (R71 / 6-09)
� ` PreuriOetl N' Departrtie(d of Lo� GovemmeN Finance
� File Mark
INSTRUCTIONS: 111
To be �led in person w by mail with the CounryAUditor or Counry Recorder o( the oounry where the property is IocatetlJ N
Fi!'mg Dates: 7) Real Pmperry: Musf file dufig the year for which fha deducUon is soughf.
2) Mo6Re / Manufecfured Homes not assessed as Real Prt�perty Must file during the AveHe (12) months
6efore March 37 0/ each year the deduclion is swighL '� 7
See reverse side Ior adtlifionel instructbns and q`ralifications. �
MP���� (°��.or contrdU bN'er - sea reslrirt'a�s or�raverse side) �i _.�_
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Key nunber / legal
al_�7 R_
Auditor
Recorder
Rem�d fwmbc � Page number
vaWe d real popeny es d Mortpage /�ontraa 4debtedn�s unpaid as d Mangage / Contrao iridebted�ss �mpaitl as d Is Ne app�rant iha sole
1, anmt yrar Mafr31 � artem yrar aate of appl�cation IeBa� «epuirada wmell
I I dOd ❑ Yes ❑ No
n iw, what Is his � ner eraa sha.e o� inreresc7 rc wnrea wim sa„eure aher u,an spa,se. �nakz�e vrim v.+,an
I! name m r�md'o Oifterent Nar�_tya[ 1 appAwnt, hMicate bebw: 5 Cce property in QuesOOn: MnuaOyASSessed
L.
Armu
I ✓ �� ❑ Mohile�� 1.1-i
Name of nartpa9ee or mntracl e� Caw_
ACdress of mortga9ce ar mntraU seDer (numbel erM stree4 cdy, sfe�, aM LP cade) _
Name ot a5signee w atl�u wmer w hdder of rtartgage
AEaress oi assignee (number end sheet mY. smte. enc
ooes apWinm w.+� woc�' � eny aner
���,����
❑ Yes ❑ No
Drduclirn appfwad in tl�e amount oE
20 20
' _.._�- --. _' _ _
Dra�ver NO... �4�Q.......
Cal'd NO. ......�.Q3O........
� ISI,OOO,�'
5(3 ��
COUNTYAUDROR
20 _ � 20 _
Counry
20 - � 20
an �a�e�d w, woaertr
20
t/ We certify u�der Ne penalty of perjury that the above arW foregoing infamation is true and mrtea aM Mat the appli�ant is a resident of InEiana aM
owner / contract buyer of the afaemeMioned prope on date appli�alion is filed.
�a (a'�r3 ry�p ^ffi"°) . �i ^ / Date (monfh. daY. Y��)
F ent �OOress 6f appWant (wmberand sLeet �: �te, antl ZIP
/o83Z S. ssa ��sT
Puson autlroriieE Cy dWy �ewteE Porer of Attomey rn by IC Fri.1-12-
Address of auNw''ved persan (num0er arM street �dY. state. an0 ZIP mtle)
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