HomeMy WebLinkAboutMortgage_JenkinsSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
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� Presaibed M�b af Laal GaemmeM Fuance
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INSTRUCTIONS: �ed
k be filed in person w by mail witA the CountyAUditor or Counry Recorder o! tAe county wliere tlm poperty is located. A u �� �
Fifing Dates: 7J Real Properly: Must file durng the year for which the deduction is sought Counry AuCitor
2) Mobde / Manufaaured Homes rat assessed as Real Property Must file dunng the fweHe (72) rmnNs
6efore March 37 of each year Ne deduction is sayht. ��C�w"ry' Remrdu
G� h� /�"
See reverse side !or addiEena/ insfrucUOns and pu�lfications. � ' . . _. _ . .._.__ _
� � ����a���, ��_ acn- oo 1.9� a-oay '�„ p P�° 3a�o
vahie rf � PoP�Y as d y���'q^�.� irde6ted� u�Va� as W Morigage / ContraU uWebtedness unPaiC as d is Me aP�� Na sole
MBIUI i. YMCI[ )P.Bf M81tl1 � /�\ EBIG 0( 9PP�� �28d� O! �II�I2EI2 ONTMf1
O C/(J ❑ Yes ❑ No
tt ro, what is h's I her ued shara of intarest? H owne0 wiN smreone oUrer than sV�a. 6dirate w40i whom
tt rwrie m mmtl o SAtercrt Nan Nal W aDP�C Ind'wate bebw. Is ihe WoO�Y in Vueslim: MwaDy Assessed
❑ Re� �o�env ❑ a,^�,a�y w�e�ea
n�oeae rroa�e c �t�-
Name of rtnrtgagea or contract se�ler
ACdress of mortga9ce ar mntratl se0er (numbg and 9reeG , smm, ane LP code)
Name af assignee a oNer avmv v halder of mMgage
aeeress or ass�ee ���ms
�l
ro sanet �: smre. ena ar moe7
mry dAc If yes. �Miat muntyt
Yes ❑ No
Wha� Tadfg D'atriG7
�uaim Deen (e9uestm m G�Y
�n ❑ Yes ❑ No
Dmu�on aCW� 6i Ihe am-- _
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D1-a��'cr 1 � � �
3 . . . . . . . . Counry Date (rrunfh. eaY• Y��
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� y' I� __.,.,w and foregoing infwmatlon is We and cortect arW that Ne applinnt is a residerrt of IrWiana aM
..�.,�ementianed propertY rn date ap�'�cation is filed.
� Date (nmth, daY.Y��) �
�n �h�� � �
F 1 " ent a0�as of aDW (wmDer an0 5Hee4 �1: sbte, end ZIP mtlej
Puson aWnraM Gy At9y ezewted Porer d Altart�eY � M IC &1.1-12-0.7 ' I Data (rnmth. daY. Y��
P4Cress d auNarsed person (numberard mee; city. state, aM LP mtle) .