HomeMy WebLinkAboutMortgage_Iafrate"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C'oun ' Year
FOR DEDUCTION FROM ASSESSED VALUATION /
— s�c, F«,,, a3,o9 cR,,, �> 0 T 1 5 L U tu L/
�,,,, aresmbea M DepartrneM m L.ocal coremrnam Fuia,xe
File Mark
INSTRUCTIONS: �
b 6e fi7ed in person w by mail wifh the Counry Audifor w Counry Recorder of the wunry whele the properry is Ior�tedSON O� y
FiNrg Dates: 1) Real Property: Must fik durirg the year for whicA Na deduc[ion is sougAG �t� �(ii f��iditor
2) Mo6de / ManWaCu/ed Homes rat assessM as Real Properly: Must file during Ne twefve (72) months f,�
6efae March 37 of each year the dedudion is saght � U C��ry Recordu
See reverse side (or adtlitional insfructions and qualificafions.
p'opert� as of
no, what is his I tcer ena shaie of interest?
�3-ll-zo0 -
Mortqage / Canbaa �naehreanss
Mard� t, anent �ear
If rwre m femd'a QRelent tlian Nal 07 app9canl,
�I .r..??
a����ffi�.
or otliu avmer or haltler W mortga9e
��umee, ene �neec �: �te,
appfrrnt own property in any otlra
y m Indena? �
❑ Yes
L
clion appmvad in Ihe amouM .
2c� _ I N •
u yes, wnac mumyl
No
I � 1
( 01-o d �� I s�l�
��������a��
�. ot appGptim
mmea're otlmr Ihan s0a+se. md'Kate wtth r
iitade ow�u/l
Yes ❑ No
P�D�Y in 7uestim: M(waAY Assessed
�IPmpeKY Q!vmuatlYPse�ed
a�,�...... —
Dl•;l\\'Cl' \0... • �— 1�
� ,,.... . .. _
C�l,� �p. .........
�a�3,� - ,P�
� LJ Yes LJ No
)UNTVAUOROR 2
� �� i
20 _ 20 _ 20 _ 2�1 _
cwmy � oa�e (�,m, aer. r��
urWer the penalry ot perjury that ihe above and foregoing infortnaUon is We and cortect and �hat Me applit�nt is a residertt of InCiana and
ad buver of the abaementloned property on date application is filed.
3
Cy duly
IC 61.
Adtlrea of aN� 7e� (numEer ared stree4 �Y• smfe. an0
„_�,