HomeMy WebLinkAboutMortgage_Raley (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownsnip Year
__ s FOR DEDUCTION FROM ASSESSED VALUATION
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S � Preivibetl by �epaM1ment of Lo�l GovemrtrerLL Frence
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INSTRUCTIONS: �n�� qp1y�d
To 6e filed in person w by mail witA the CountyAutlimr or Counry RecnNer of fhe counry where the property is lo�mq F C U � U���
Fiting Dates: 7) Real Pmperty Mus7 file during the }rear lor which the deduc6on is sought � County Auditor
2) Mo6Be / Manufactuled Homes not assessed as Real Property Must file dunng the fweNe (72J months � County Recorder
6efore Maich 31 0/ each year the deduction rs sought. `Yn
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See 2versa side /ur additional insWctinns and qualifications. Q V
`�(owrerarcmtradbuyer- e or�rerersesid "
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aare�n year
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name on
Name m mongagea «crnaact sener
Address U rtnrt9a9ee w mntraG se
Name ot assignee w other awner or
r I legal dewiption
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Mortgage / Contraa intlebteEness unpaitl as
Mard� 1, a�rtent yeer
i�Wipte bebvr.
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MortgagelCOntrar]
date of appGcation
Daes eppliqM ovm pmperty in any oNer I If yes. wtiat munt�? I What Ta�drg District7
munrymindiana? ❑ Ye5
❑ No
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sdness unpaid as d Is Ne applksnt the sole
� legal or eWitaWe ameR
O (YXl ❑ Yes ❑ No
property in Question: MnueM Assessed
�I PrOperty ❑ ArmuallyASSessed
Has iha deduaim been ie9ursted m v�Y
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� COUNTY AUDITOR
DeCUC�an app�wed In the amount af:
20 _ 20 _ 20 _ 20 _ 20 _ 20 _ 2(1 _
Sig�anne W Counry Audimr Caunry Date (monN, daY,14a�)
I I We certify under the penalry of perjury [hat Ihe above antl (oregoing informalion is We and mrtM arW Nat the applinnt is a resident of IrWiana a�M
owner I contracl buyer of Ne afwemeMioned property on date application is filed.
sig wners mm �ame) oate (nrmu�, mr. yea�
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FWI msiCent address o( rent (num0er antl stiee( dry, sLate, ard LP cotle)
Q� '�Deer/�1Nd �I`• f��J�Sf/r�6T i„i y��3S
Pelson autho�¢ed Ey duty esewied Pwrtr of AttorneY m M' IC 67.7-t2-0.7 Date (mmlh. OaY. }ee� -
Pddress of au�hw'ved person (numberaM sheet. ciy. stata, en0 LP code) . . '_' ' '