HomeMy WebLinkAboutMortgage_Glaser (3)i
^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
�,_ FOR DEDUCTION FROM ASSESSED VALUATION
�• State Fartn 43709 (Rt t/ 6-09)
��w, � PresciEetl by OepartmeM of Local Govemment Flrence .
'le
STRUCTIONS: F� �� �:
To 6e fifed in person or by mail with fhe CounryAuditw or Counry Recortler o( the county where the property is bcated. AR �O �
Fifing Dates: 7) Real PmpeRy: Must file during the year (or which the deduction is sought. �ty quditor
2) Mohile / Manufactured Homes nof assessed as Real Property: Must fife dunng the fweNe [12) mon(hs
be/ore March 31 0/ each year the deduction is saght .�. f� ry R��
See reverse side /or addtional instructions and qualificafions_
App�mam(oxnerwcontraGDuyer-seeres�rictionso�r�ve+seside) � NTY AUDITOR
Me�d� t. �+rent 7,mr
If no. what fs his ! her e�ct
If nar're m �emd'o tliRere�
Key rwmbeF / legal tlesrnPtbn
- �-d - �
d �ge / Contraa�4
Ma 1 artent
ofinterestt
that of aPW��4 u�tlifate Debw:
Name of mwtgagee a mntracl seller
Address W mor19a9ce w mntrari seJler (
Name oT assi9ncre or oNer owner or hdd
AEtlress ot assi9nee (number aM sUee4
Does appli2nt am property in any oNer
muNy in Ind'ana? ❑ Ye5
1
p¢Eurmn appoved'ci the amount oE
20 20
Sig�aWre of Cow+NAUtlitar
C -T 7'y
I I We certry ufWer 1he penalry ot
� er I contract buyer ot the afor
o�mer's h+9 name)
msitlent address W t (nu
/�9� S�',c_ r
Recoitl number Page number
-3oo_Do/,5�3-o�Y �.o� lz8�
htetln�s unpaid az ot Morigage / Contrui iMeMedness unpaitl as o( �s Ihe apd�t the sde
date of a7P��ation '1 legal a equitaWe wmdt
d� 5 Q � � ❑ Yes ❑ No
If ovmetl vri� sorneone dher ihan spousa, iMrate with ��irom
Is Cx ProPertY in Qunstion: Mm18Ay Assesutl
�eal Property Q Mmually AssesSed . . .
nran0er end sbeet d(Y. �g. and ZIP code)
er ot mortgage
tlry, slate, arM ZIP catle)
��,�.��W��M
❑ No
�o��
20 20
al Altorney
authoraedpersa+ (numberarMSbee4
above
sfate,
Dra�ver NO..� � �-
Card NO. .:. �
a.�.a
�
�l �.S�bix�. c� ......
2(1
�
�ate (rtbnM. OaY. l'��)
F��7
�
❑ No
infortnalion is true and mrtect arM Mat ihe applirant is a resident of Indiana ard
ion is filed.
Date (nmfi. daY. Y��
Date (monN. daY. Y��