HomeMy WebLinkAboutMortgage_Booker"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�, � FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Fwm 93709 (R71 / 6-09)
,,,,, � P�esaibetl by Departrtient of Local Govemment Frence
Fil
INSTRUCTIONS:
To be filed in Form Aed with: �O»
person or by mad with the CountyAUditor or Counry Recorder of the county where the property is located. e
Filirg Dates: 1) Real Property: Must file dunng Ne yeai Por which fhe deductlon is sought. M� o Counry Auditor
2) Mo6de /Manufactuied Homes iat aaessed as Real Pmperty: Must file dun�g the tweNe (72) months
6efore March 31 of each year Ne deduction is soughf. C, �
See reverse side for addifional inshuctlons and quali�ratbns.
AppGant(owne�gcc�o-ertb seerewicbons�versesiee)� /� C.IBSON C
s�ea vanie m rr� pmpery as a
aRh 1. tlrreni yeer
no, what Is his / her era�Y shara of
=i =yo� =��300-� . g�-� ,�„�,�r r°"ao
Alortcage / Conbaa iMe6ted�ress unpaid as af Mortgage / CmVari i`Webiedriess �mpaiE as of Is ihe appfirant the sWe
Mamh 7. a�r�t yea� Gate of apP���� kgal O Y�de amen
a� � a ❑ No
If name m recortl's Gitt¢renl ihan Nat W app6cant, u�Eirate below.
convaU se0er
m«t9agce «mntraa
or ou�er owner or naaer m mMgage
•��
� y.:g� ,v12° v cE �
ALdress of ass"syiee (num6e� and stree4 �Y. �te, antl
Dces applkant own pop�ty in any oNer ��� �
munry in UWiara?
❑ Yes
zo � � � �
oZb� ( -a o� 3
20 � �
Is tl�e D�OeRY in GuesOOn: Mmie%P.ccssed
❑ Real Property ❑ Mmually Assessed
1as Nis dedudion Deen re9uestetl m praprny
w artent yea(.+ ❑ Yes ❑ No
�s����
i/ We certify under the penally of perjury that the above and foregoing infortnalion is true and mrtect arW that the appliqnt is a resident of IMiana arM
awner I mntracl buyer of Ne afpementioned pmperty on date appliption is filed.
♦
slate,
Power o( Atforney w by IC 61.1-12-0.7
Address of authoraed person (number aM sbee4 �M state, and LP cotle)
bate (monfi, daY. Yme�
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n�a (monN, tlaY• Y��
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