HomeMy WebLinkAboutMortgage_Hecker"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou sh' r
= FOR DEDUCTION FROM ASSESSED VALUATION
�• State Fortn 93709 (R71 / 6-09)
, � PresaibeE q' �eC��rd o1 Lod GovemmeM Fuance
File Mark
INSTRUCTIONS: r
To 6e filed in person or by mail wiM the CountyAUditor or Counry Recorder o/ fAe counry where the properry is located. Form e .
Frlirg Dates: 7) Real Properry: Must file durirg the year lor which the deduction is soughG Coun Auditor
2) MobRe /ManulaGured Homes not assessed as Real Property: MuV file during Me tweNe (72) months �� LS��
6efore MarCh 37 of each year Me deduction is sought. L} C.uun er
See revers side /or additional instfuctlwis and qualifications. G16S
Appfxant ncontr�ctbuyer-see�rlimsw�,reversaside)
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P•l'dCI5I12f8 W VISCICSi��
w, �o,00a..3s�d-oa�l ' ib ' �
#a� iMrbtedness unpaiE as W Morigage I Cantrscl ctl�]eMeOness �mpad as of Is Me applkant the sde
tl Y� Cate of applxatimV/ Y� �, l LA_J �❑ YPSe ❑ oN
If fwrie m remd is dAterent than �hat of appBCani,'uNUate Eebvr.
Name of mwtgagce or
naaress or �ortgagre «wno-aa
w
w aNer owner or hoWer ot
antl atrceG �Y. staf€. anA
Doe� epd�,nt ovm P�D�Y in any aher
oounry m Intlana? f'l .,' _
20
sgreuue
ee4 �aY• sfate. erM e
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Z/P m0e)
If yes, �Ma[ tountr
20 I 20 I 20
SOffIlbllC
Wf10111
ie property in GuesUm: MnuaDY Asrssed
Real ProPeKY Q %vmuallY Ass�sed
_�._�_
VJhat Tadig Distritl? ��[�(�
]�1':l\\'CI- 1�..."•"' I..........
,�oROR �55 (�, ... .. .
c��.� �o . .............
— 20— Wo���I'0�.� .,,_
�I/ We cert'rfy under ihe penaly of perjury that Ne above arM foregoing infortnatlon i5 true end correct and Ihat the applirant is a resident of IMiana arM
owner I mntract buyer of the afaemen0oned pmperty on date application is filed.
- / SIBnaWre ( �s hAl — ..... Date (+�mtli. daY.Y��)
l' /Z ,3G ZG/O
� Full rrsitlent aE U applmant (numDerantl sLee4 �Y, �te. and ZIP cotle)
9 � �1e � c,-. �/4�.. sl��l,� �•U t�763 i
w+son aw,oraed cr e�N �ea,tea ao�(er rnunmer «M �c G,.,-,z-0.� oate tmann. dfi: r�d
Pddrass of auHror'vE0 person (number arM stree; cdy, slala, and LP code)