HomeMy WebLinkAboutMortgage_Bruce (2)'° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
� ,_ FOR DEDUCTION FROM ASSESSED VALUATION
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� Presa;tea Or �vartmeM of Lad Goven,ment Fu�arKe
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INSTRUCTIONS:
To be filed in person w by mail wiN the CountyAudita or Counry Recorder o/ fhe rnunry wl�ere fhe property is locat .
Fi/6g Dates: 7) Real Pmperty: Must file dunrg Ne }rea� for which Ne deduclion is sought.
2) Mobde / Manulacfured Homes not assessed as Real Properly: Must file dunng Me twelve (12) monNs
6e(ore Mamh 31 of each year the deduction is s�uight.
See rever;g�jde for additbnal instnictions arM qualificatbns.
Assessed vdhre d real p�ap�:y as ot
MaIU� 1, anent year
If ro. what is ha / her eracT sl�are of intrRSt?
I} n3Te On ROO�d B 6RPlCnI M2(1 tlia{
I � �U�-403.3
/ Contract'ud�tedn�s un7aid as ot !M
w mntrad se0er (nember and strce4 �y. sbte.
af assignee w oNer mmer n hdder of morcgage
ot asig�e (number aM atreei ray, slt
applicant wm properly in any oNu
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EP[� �`�iQ�a��o�
rrty Recordu
I"LXX I / U J�Oi O
;gage / Cantraa vMe6tee�wsv unvaid as d Is ihe eOP� Na sde
� ot avWicatia+ �gal w aNnpNe °wrrel.'
❑ Yes ❑ No
somewre otlml Ihan spouu, hMkate Wih wlam
i Drawer NO...ei�QlO
CaCd NO. ..�Y.!U..........
� i o oo�o. ��
Caunry
IS �IC p10PCfiY VI QIIPSbpI: iV111U2%�
❑ Real ProP�Y ❑ A^^�N �
e.�� r� nc ��.
Has Nis deCUmon Deen re9uested m propvly
ro�a,^�"�n n .,__ n
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�Y,��,
� I/ We cert'rfy u'Wer Ne penalry of perjury that the above and foregoing infortnation is W e and cortec[ arW that ehe applinnt is a residertt of InEiana aM
owner I contracl buyer of the afinemenUOned property on date appfiration is filed.
e:...�,�,e i,,...,e,t Fs „s,,,e� Date (monfi. daY. Y��)
mtle)
w by IC 61.142-0J
Der'.•an (numberaM street �% sbh,
oate (mantn. tlal:
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