HomeMy WebLinkAboutMortgage_Burns"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ POR DEDUCTION FROM ASSESSED VALUATION /
- State Fam 93709 (R71 / 6-09) V
1 Presaibed M�P��M of Lo�l Gm�emmeM Finsrce
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INSTRUCTIONS:
To be filed in person or 6y mail with the CountyAuditor w Counry Recader o� the munty where Ihe property is located.
Filing Dates: i) Real Property: Must file during fhe yrear for whicA Na deduclion is soughG County Auditnr
2) Mobde / Manufauured Homes not essessed as Real Property Must file during Me Rvelve (12) rtanths n � Remdw
6efore Malch 37 o(each year the dedudan is sayhG ,�1 �
SeereversesideforadditmnalinsVuctionsaMqualdications. ,,.,,onu nn11NTY AUp�T
Mert�h 1. anW Smr •
tt ra. what Is his / trer eraa sliaie of Ntemst?
H name m mcdd is dAferenl than Nat of app[
v�o��-u•�
, •e_� �_ '
numbel
unpaitl a d b tl�e apP�� tlia soie
kgal or equitade a�+c/!
❑ Yes ❑ No
If ormeE wiN mmeafre other Ihan sPW�. irMimte wm wnom
Is the P�PenY in GuesSOn: MfwaM Assessed
❑ Real ProPertY Q;vn!ualA;Pss�
Name oi mutga9ea or mnfraU se1Mr � N�'L n v,/ ,. '
A �,
ACdres ot mortga9ee ar mntaU se�er (nunDef and sbeeG �kl: stam, aM LP cade)
Name af aRignee n othei wmer or hdder ot rtiort0a9e
AdCress of av99nee (number ard saeeC �l: �. atl LP mde)
DcesaPWfcamo+mOmPerryinanYoCw llra���cr�O....�.01.U......
muf¢y in �n0'vru? r—� ' _
an,n,m or.
2�_ � 20_
Card \'O. ...��.�.�........
� �3, lnloo, vD _
Fias Nis tleGUmon
for artent YPa/?
p
Stea m P�P�Y
Yes ❑ No
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Sigrewre d Camb Aud'rtur � Caunry Date (nmfh. daY• Y��
� I I We certify uMer the penatty of perjury that Ne above and foregoing infwmation is we and comea a`M that Ne applicant is a resident of IrMiana aM
- ovmer / contract buyer of the atweme�rooned property on date applidtlon is filed.
e:...w....., i�..,e.t nn..e,.,., .. Date (rtnnC1, daY.Y�/)
mtle)
GY dWy exenired aaviar a ntmmay w oy �
20 D� (numOer eM SbaeC �4Y. Sta1&
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