HomeMy WebLinkAboutMortgage_Titzer"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS _ Year
_„ FOR DEDUCTION FROM ASSESSED VALUATION �
• State Fortn C37W (R71 / 6-09)
� w� Presmbed q' DepartmeM af LaW GovemmaM Firarce
File MaM
INSTRUCTIONS: 0 C T
e wi :
To be filed in person w by mail with the CountyAudifw or Counry Recorder o/ fhe counry where the property is located.
FiHrg Dates: 7J Real Property: Must file dunng the yrearlor which Na deduction is soughG �-. Counry Auditor
2) Mobde / Manufadured Homes not assessed as Real Propeny: Must Ae during the twelve (72) montl�� nty Recordu
be/we March 31 0/ each year the deduclion is saght.
See 2verse side forado'itional instructions aM qual"�l'ications. G�BSON CO ' K
(o�nelormrvraC 6N'�f' see m_wia'ons m rewrse aida)
�Yd41G O( (B21 PDD�Y'd3 Of
1, fi�V year
If ro. what ts h's / hu e� slure ot inferest7
If name m reco�tl "s E'iRerent than that of app0
Name af rtnrtnaaee or mntraa sefler
��Cer/ Idrsviptv�
-a -�� - ioo - ��i� 4a? - � a-y
Abrtgage I Cantrect 4de6tedness unpaid as ot Mongage / Con7aG tr�0ebteCr�
Mart�h 7. anentl'� . Ea4 of ePP��
AdNea d nn`tt�a9ce ar mntraC se�n (numbrl and shael �Y. smte. ard i
Name N assignee or othrl avmet or hdAer of mrtgage
ADtlress ot assi9nce (number and ahee4 �RY. smte. aM LP tade) �
Does apptimnt o.vn pmperty in any oNU If , wtiat mum7?
munty m Ind'ana?
❑ Yes ❑ o
D�ucaon appiwrsd'vi ihe amoun[ af:
�
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Remrd rwmber Page numOrf
si <-,' 8
Id103b 23 0: �9I�18 Hp�l� 1:18 SO�B
kgal or eQURa61e oa�re(1
❑ Yes ❑ No
W"rate wiCi rAwm
Is ihe prope`ty in 4uestim: M�waOyAssessed
�� �nv ❑ ?+mya�!r a�d
� � � � �
Wtmt Tadrg Distnr27 Has Ih's � Ecen re9ursted m pmperty
��p� ❑ Yes ❑ No
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1 I We certify u r the penalry or perjury at the aDOVe arW toregang infortnal
owne� contra Yuyer of the afaeme ed property on date applkation is fik _.
fii0
or by IC
Mtlress of aWmr�d persm (num6er en0 sbeeG cily, steta.
(munfh, deY, lee�
�Y. Y��)
iana arW