HomeMy WebLinkAboutMortgage_Aders"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ou s Year
FOR DEDUCTION FROM ASSESSED VALUATION
s�e �am a��os cR„ i sas� C/
,' y,. PrestriEed by �epartmeM N LoW Govemmeni Frence
e Mark
INSTRf/CTIONS:
To be filed in person w 6y mail with the CounryAuditor or Counry Rernrder o/ Ne coun where the F� ��
�l' P�PertYklocated:,r7
Filing Da[es: 7) Real Property: Must file during Ne year /or which the deduction is sougAt }� O�"s �C��ou�n�ry} Auditor
2) before March 3� f each year the deduction is sough��m" Must h7e dunng fhe (welve (72) G�SSt� C U N'� A L3unfyRRemrder
See reverse side /or additional insWUions and qualifiwtions. �
' istrid Key �wmbu / kgal desaiptim Remrtl wmCel Page rwmDer
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Assessed vahie d mal pmperty as of Mortpag e/ Contraa Inde6tetlness unpaid as of Morigage / ContraG uWe6teErmss �mpaid as d Is Ne appOrant the sde
nmm �. a.re�c r� Mar�h t. ame�n r� eam m aav�+ � a ewaaae o-�„en
S D D ❑ Yes ❑ No
rc ro. what s ha / ner eraa share or interesc7 rc awnea win, sameone mtw� man spa,se. Ine�ate rim wMm
If name m iemd is EiRe2nt 4qn Nat of aPP��t 6Wicate Delow. Is Ihe in puctian: Mnua%ASSessed
Re91 Ptoperty � Armually 0.sseued
a� r�,� nc ��.�-�
o( nartgagce or cantraG seAer (numbe` ard sbeeG �y, stam, and LP cada)
Nama of assignee w oNer owner w MIOU d mortgage
Address of astignee mbar aM atreef, my. slate, arM ZIP cade)
'I� Ll..% N r.�� � �
Ooes a�nt wm proprm� in any other I( yes, wha[ mun
ue�u�vm apprwea m ma amount ar.
20 _
SEiuMe d Camry nudaor
.�
?p _ � 2p � p'
i/ We certify ur�r Ne penalty of perju at the a6ove and foregoing
owner / contract Wyer of the afoieme oned property on date applira
s /`f-.OP�L f
ant (numj�er and strpeL riry, srate, end ZiP ome)
pe�son (numba�aM sCee4 �y, state, and LP oode)
/ /1 `
r�( radng ocafna Has mo aeaumo� oee� rey�es�d m propucy
S - - - r� ❑
(Y� i�.� P�-� �:K�S
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Date (
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70
i residerrt o( Irdiana and
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