HomeMy WebLinkAboutMortgage_Coomer (5)°^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
s�e F«m+a�oe (as r zo�>
�' ,�„ � Presmbetl bY DePatUnent W local GovemmeM Fi�nce
INSTRUCTIONS:
To be filed in person or by mad with the CountyAuditor o7 the county where tlre property is bceted.
Fding Dafes:Z� Mobiie Harres �ses�ed under IC g-76elw�JU�ni�ant ary 5 and Marchb2 of the year�eductirn iyya.ge �e�li��U6
See reverse side for additional insWctions and qualifications.
Apqicam ( ei mnvad d7y¢��{eyr�i¢ia� reverse side) �ili`%%� Y l SLl 1
} V I ��I (' n, f\ /1 7Y AUD17�R
�r ai;arvn I K«v1' n�i � o3drsaia;on �IR Remrd numn�r Page rnsnber
value oF real pmpaty
his / har exacl share af in�e2st?
name m recard is Eilte`enl ihan ihal
Name
_ ao`'a -ocb � cd � -o a
rtgaup,A.GontraC uWebtedness unpaid az of Merch 1, Is Ihe app6ranl Ihe soie legal d eq�ti e umell
�erd y�L. � J O �
❑Yes � No
If owned wtlh someone ather Ihan spouu, indicate with whom.
Addr�s of mortgagee or oonlraG seller (number arM �ree4 tity. 9ate. and :
Name of assi9rrea or aU�et u.vne� w holder of morigage
%
Address of assig�e (mxnber end sbeel. dty, state. arW ZIP mde)
Doas apqicard am pruperty in arry aher If yes, what counly?
cou(riy m Ind'u�7
❑ Yes ❑ No
Deduction app�oved in Ihe amwM
�rL•��
COUNTY
zo � zo
Sig�Wre of Counry Auditar I Counry
1 I We certify under the penalry of perjury ihat the above and foregoing infwmation is We ai�.. __
Indiffiea and owner of tl�e afwementioned D�oPer�Y � March 7, 20
Person
ity. stafe. and ZIP oode)
�
or by IC 67.1-12-.07
of auUqr¢ed persai (number arM sheeG aty, sfafe, arM LP oode)
Is Ihe property in ques6m:
❑ Real Property ❑ Modle Hane QC 61.
Has Uds dedudion bean requesteE on praperty
for ainent yean
❑ Yes � No
\
ra �ti�er 1y� '
o..�_ y��s,
Card iVp.
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Date (monih, day.
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