HomeMy WebLinkAboutMortgage_Goldman.t °m STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T ip vear
FOR DEDUCTION FROM ASSESSED VALUATION
s�e �,,, as�os �rts � zd�
S � r.�mbea br oeoan,ner,i a Lod c�o,emmera Firence Mq r
HM
File Mark
INS7RUCTIONS: '�y�
To be filed in person or by mad wifh the CourMyAUditor d the couirty wheie the pioperty is located. p�!Q� �'�'�'2
Fding Dafes: 1 J Real Property: During the 12 months be(ore June 11 0/ the year fhe deduction is to be efleclive. �/ �J
2J Mobtie Hames assessed under IC 6-1.1-7: Be(»een January 15 end March 2 o(tfre year U�e dedu��iD�tTaQ6��AU0iTGR
See reverse snie for eddGonal instruc6ons end qu2Gficatrons.
4y number / lega
—W�Ai
3� 1, anet4 ymr
his / ha exad share aT
If rame m recwd
desaiplion
�'UE�CJ.UJ
3e / Contrap indebtedness
Y� . /7 .� �
cadress uf mongaqee «c«,vaa seller (numner ara 9reet. aty. sare.
Name af as.tig�e or ather o+rner or
Address
Dedudion
20
a5 of Match 1,
with wmeone oUrer Ilwi spouse. indicate
ardZ/f �I�il�\'�'�� �io..ao.o..9.
rwmbar
sde �ega� « equitade wrnen
❑Yes ❑No
Is Ihe praperty in queSUm:
❑ Real Property ❑ Modle Fiane QC 67.
wem ��y wner ir y //-/� I Has u�s aae�aan neen .e��+ea oo �eny
C8I'Cl �'�. .....1..1� ............. raa,❑emvean
❑Yes ❑No ❑Yes ❑No
/�'ybD,,o � 190,�q�� do
itheamountof. ��^�^�-6�� �� c�tis�
20 — I 20 I 20
i
20 _ I 20
Date (manth, daY. Y�A
1/ We certity under the penally of perjury ihat Uie above and faegoing information is true and correU and tliat the app6nnts vras / were a resident of
I�ana and owner of the afwementimed property rn Marc� 1, 20
s(a(e. and
AttarneY or
Adtlress d aulhoraed petson (num6ei and sheef, r�y, sfate, and LP oode)