HomeMy WebLinkAboutMortgage_Tenbarge (9)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou wnsh r
__ � POR DEDUCTION FROM ASSESSED VALUATION
� .. • Stace Fwm 437091R71 / 6-09)
S,.�. � Presvibed by DepartmeM of Local Gmromment Frence
wsraucnoNS: � �� � 009
Fortn t�ed with:
To be (led in person or by mail wiN the CounryAUditor or Counry Recorder o/ the county whe2 the property is located.
Filirg Dates: 1J Real Pmparty: Must file dunrg the year /or which the deduction is soughG `-y,�j CmnWqudimr
2) Mo6de / ManuFacfured Homes rwt assessed as Real Property Must file dunng the fweHe (12J months 0�,'��� �� ��"
befae March 31 o/ each year the deduction rs soughL L[% �+���e�
GIBS
See reverse side /w additionel instructions arM qual�cafions.
Ap �(owner m oontrad euyPr - see restri�ons m mverse side)
_ ._,._...__..._�._�.��.
�-a3-/s-�oo-00% sob- oay o09 �8
f raNe d mal property az of Mor�qage / Conbact intlebtedness unpaid az ot Mwtgage / Contrac[ inEebtedness unpaid as ol Is �he app�mant Me sole
wreN year Mamh 1, aG�rtent year tlate o( apP�� Iegal or epuitaWe amrl�
�_)� C7�C� ❑Yes ❑No
ro, xTat is ha / �er e�cl
narrie m
���a����y��
Address of nwrh�a,ryee or contraU seDer (numbrs end sL
Name oi as4gnee or othu awner or hdder of rtartgage
Address o7 assynea (num6er aM streeL dry, stale, antl
Ooes appfitaM ovm property in eny oNer
munry in Ind'ana?
❑ Yes ❑ No
DeCUCtion appmveE In Ne amount of.
��-
slafi, aM Z/P code)
If ormed with someorie other Ihan spouse, indicate with whom
Is the P�PQrtY in QuesCOn: MnuaDy Asessetl
i�.Fteal ProPeAY ❑ Mmualh� Psse55ed
.�!'�iti'C'1' 1�` .
o....abo9
Whal Tari�y Disvic
� C:1�-v 1�r� .. �P
COUNTV AUDROR �" aSO, u�a �$.� .. . .. ..
20 _ � 20 _ � 20 � 20 _ � 20 _
� I Sg�ture,^ W Ca�tylwdicor
i �.--v� v
Caunry
20 _
Date (monlh, daY. Y��)
cv
1 I We cerUfy {(ider the penalty of pe� that ihe above aM toregoing infwmalion is we and cortect and Nat Ne applirant is a resident of InCiana arW
amer I contracl buyer ot ihe aforem oned property on date applipiion is filed.
��ture (oxyers lull riame) j. Date (nwnth. daY. YBeA
� C �
Fuil nt atldres of appfeant (numDer a
2so� � !�
Pelsan auUai¢eE Dy Euty exewtetl Power �
tly, sfare, ard 21P ootle)
person (number eM sbeet. fity. state. arM LP tode)