HomeMy WebLinkAboutMortgage_Fields"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T h r
FOR DEDUCTION FROM ASSESSED VALUATION
�� � StaleFama37W(Ri1/6-09) DEC 7 ���
,�,� PreSaibeA by DePartment of Laral GovemmeM Fi�nce
CFile Ma
INSTRUCTIONS: '�
To 6e filed in person or by mail with the CounryAutlitor or Counry Recorder o( the county where the property is located. F� ��
Fd'mg Dates: 1) Real Pmperty: Musl file during the year7or which the deducfion is wughG GIBS N�UM�p�ql/pp1�R
2) Mo6i/e / Manufactured Homes rwt assessed as Real Property Must h7e dunng the tweNe (72) months
6efore Ma�ch 37 0/ each year Me deducfion is sought. ❑ Counry Recorder
See reverse side (oradditional insWCt'nns and qualifications.
Ao ' rmmAraC6uwr-see on ' eY A n
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.7 : � :
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- 3 - /� - d0 _ oo,
MMgage / Contrarl iMebtedness unpaid az o(
Mard� 1, wrtent year
Name ot mortgagee «mntau seUer �/ n
�/
Pddress M mort9a9ee or cantraG seller (num � erM sD
Name of assi�ee or othrr owner or hdder of nqrtgage
ciry. srate.
div�n ovm property in any aher
Indiaria? ❑ Yes
❑ No
Deduction approved in Me amaum
20 — � 20
Sig(ature of CamtyAUdhor
ee4 cM slate. and Z/P codej
��/.L1e
ZlPCOde) �
If yes, whal county.�
2(1 � 2�
What Tadrg District?
= � � RemrE rwm0er Page rwrt�Ce�
7
raiY'uWebteEness unpaid as of Is ihe appl'cant 1he e
�n legal a epuitade w.rnY!
� �� ❑ Yes ❑ No
her Ihan spouse. md�te with whom
Is th property in puestion: MnuaAy Avessed
Real Property ❑ Hrmually Assessed
Mob�e Flane QC 61.7-;
� #a c��7�
Has Nk deEUaion Ceen reGUesfed m DmpertY
for �vrtem Y�r r-� .. r-� ..
Z� - FS ELD 5, M T R.o�T
I I We certify nEe. ihe penalN oi perjury Nat Ne above and foregang information is W e and cwre
owner / buyer of the ed property w� date appliration is filed.
�Sig wre Isfi�Ona �/
�Fu0 ' nt Wa� t(nurr iandstreel,yQy,state,andZlPmd)
� /2<.D/ S, ,�e�L/ � . �J ��63
Pr�son authaaetl Cy Cury ezewted Power a(Attnney w by IC 61.1-12-0.7
Pdtlress of aulhoraeE persm (numDer a� sLee4 ti(y. State.
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