HomeMy WebLinkAboutMortgage_HambySTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C un 7ow ear
__ s FOR DEDUCTION FROM ASSESSED VALUATION
� smce �,,, as�os cRn i sos>
,,,,, � aresaieee nr oecartmea a Lopl co�emmem Fu�a,ca
Ma�����
INSTRUCTIONS:
Fmn Ned with:
b be filed in person or by mati wifh Ure Cowty Autlitw w County Recorder o/ the county where the pioperty is located. ��/�
FiTing Dates: 1) Real Properly Must file durirg the year for which tha deducLOn is sought. h2�qu"� q�diinr
2) Mobde / Manu(adured Homes rat assessed as Real Prtiperty: Must fiie dunrg Ne fweNe (12J months � C!
betore March 37 0l each year the deducfion is sayhL G IBSO C 7Q°�e�
See reverse siCe (or addifiunal instrtictbns and qualificafions.
App�erar�t(�wner or m�vae 6u�er� see re.unc0ons m nwx sida)
A�1 vaAC oFteal Vq�eM1Y as d
Mm� 7� pmnl year
1/
fl ro, whe� fs his / her azad s11are of internst7
tt nane m rem�d "n drtlemnt Nan thal N appl
Rto d
I
Name o7 rtaR9a9ee or �tr�tl se9er
`�� 3
Address oi nqrtgagee m m�tracl se�er (num
�'°`�" R d o o Pa o 6 c
age/ Contraa 4de6tedness unpad as d Mongage I CantrafY i�ebtedness �mpaid as d Is the applimnt the sde
1 n�rrem v� aate a aov��+ �gal or eqWade ownen
�i%��� ❑ Yes ❑ No
.^..I
and sllee4 �y. state. ard LP rode)
w t+oldn of rtwrtgage
AeCiass of assignee (number eM sneet �}: stafe, and
ooes e�ra own aocenr �^ a^y �
countylnlnd'au? I-'1 ..__
arnpmc m
20 I 20
tl owned wiN swneme athar Nan spouse.
couNn aunn
20 � 20
��n
I I We certfy under Ne penalry ot perjury Mat Ne above and foregoing infortnalion i
owner I mntract buyer of the aforeyientioned property on date application is filed.
x y.�rw�2�os �6s7.o,�
Pe�sm autlroraed Dy Euty rseaned Pawer of Attorney w by IC 61.1-1 -0.7
Adtlress N auCm'ved prnon (num0eraid snee4 ciN. s+afe. eM Z!P cede)
�Is jth�e popercy in puestion: MnuaOy hssuseE
�.`eal ProPem' 0 �^�Y �
Modle Ftortie (IC 6
1��m� `�
�aV�d�
s�-�
aoi�
ao �t�
�ate (monlh, EaY. Y�A
Y
�