HomeMy WebLinkAboutMortgage_Dilger'°+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun sh
__ , FOR DEDUCTION FROM ASSESSED VALUATION
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,' ,«. f aresaitea ey �epartmem or Laa� Goremrfrent Fren« ,�J
INSTRUCTIONS: �t� 2010
To 6e ned in person er by mail with the Coun Auditor or Coun Recorder o/ Ne coun wHere the F� �� �:
Filing Dafes: 1) Real Pro ry ry ty ��m ��r�
peRy: Must file durrrg the year Por which the deducLOn is soughL Cq�p�/wd'rtor
2) Abbde / ManWadured Hanes not assessed as Real Properiy Mus! file dunng the fweHe (12J rrronths N r��,
6e(ore Ma�ch 31 of each year the deduction is sought. �Caunty�tecordu
GIB
See reverse side lor adtlitronal instrticGons arM quali�ications.
Vh n�n���// ���7'F' l�///1 e.�. .1 �/�% � 9�n . I 1
ro�
- 00-QoD. .3/� �!Oo7� �io %
I rahre of real pfoperty at ot '�e / Cantract irdehtetl�s unpaid as N Morigage /p �Coanb�o�ct "uWebteMess unpaiG as d Is Ne eppl'rcanl ihe sole
a�mm Y� Ma 7. artent Y� Eate of aD //_� �f ❑ Yese m�+�dl
�E� ❑ No
ri a his / her �rad share of intnm_st1 H wmed wiM sommne dher than spousa. indicata with whom
tt�me m ieard is CMemn Nan ihat oi app�canl,
Name W rtrortgapee or mntract se9er
I� A
AAdress d rtnrtgagce w contraG uAer (number an
Name W assi�ee w other ovmer w twlder of mortg
Mdress ot assignea (num6er aM stree4 �Y. �fe.
Does aPdimnt rnm 7�7enY in afry ahel
munry in Indena?
❑ Yes ❑ No
Detlumm approved in Ne artnunl oE
�
Synanne oi Coimb Aud'rtor
e prop�ty in Vu�tion: MnuaDY AssesseE
Real Pfoperty � Mnualy Assessed
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nat muny� vmat raang oatriUa • • • • ' " �• • • • • •�i
�ard� �' ' � I� p00•
COUNTYAUDROR
20 _ � 20 � 20 _
Counry
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20 20 _ 20
Date (monN. GaY, Y��
I/ We certify uMer Ihe penalry of perjury fhat the above arM toregning infortnation is true and correct and ttiat Me applinnt is a resident ot Indiana ard
owner I contract buyer of the atorememioned pmperty on date applicatlon is filed.
_ / re �owrers fiID re
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� FWI ident add�css of apP nt (number and street �Y, �le, anALP
il S Nciu(�sfiaa-
Per„on tlWy ezew�etl Power o(Anor�y w by IC 61.1-12-
perso^
5fafe. erM Z!P cnde)
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Date (monfi, daY. Y��
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