HomeMy WebLinkAboutMortgage_Deal (12)'°� STATEMENT OF MORTGAGE OR CON E Coun 7ownship vear
_ + FOR DEDUCTION FROM ASSESSED V I N
—.. ., State Fortn 437091R71 / 6-09)
�` / P�pwib¢tl by DeparbrreM of Lotal GovemmeM Firerce
JUL 2 7 2012 File Mark
STRUCTIONS: F� �� �:
To be filed in person or by mail wiN Ne CountyAuditor or Counry Recorder of pte'tn e prvperty is locafed.
Filing Dates: 1� Real Pmperty: Must file during the year /or which the deduction is sough� County Auditor
2) Mobde / Manufactured Homes rwf assessed as Real Property Must file d g hveHe (72) months � �unty Recorder
6efore March 37 0l each year the deduction is srough� I BSON C OU NTY A U D ITOR
See reverse side for addifional instruuions arM qualdications.
nppGram (owner e 6uyer- e^ _"�m reverse si]e)
Assessed�ralued2al�p�ope
Marfl� 7, amr1LL'/ear
If no. what ts his 1 Mr exact
tl iwrie an ROwd'4 Gfieret
Name of rtron9a9ea «mM
al desaiption Reto(d numl
-1S 1 or-�ro3.S�5'��7
�age/C�a G'udebtedrress unPaid az ot Mortgage I CmtraG i�Mebtednrss �mPaid as of
h 1. ou�ftLe�O O_^ Eate of appGtation
��� � l.l U
If wmad win someone aher Ihan spouse, i�diate Wlh v
o( aP��• uN'uxte belrnr.
moMgagee ar cantraG srder
or dhg owner or
'
7/� /�/� /�� '_ "'—'"�--�..f]IPCOtle).
(_Y! "`-"-'. W
� DI':11}'CI i���...�V1-.�.5
.....
Card 1\`0....�I��
................
aM ZIP cade)
1/ We certify under the penalry of pei;t}y that Ne above ard
owner / conVact buyer of the aforementioned property on da
n(num rantlstree;
i � ii
auihoraed 7y eWy
Adtlress ot a� pe�sw� (number and sLee4 �y. sfate,
(olo(c
����
iiFable a�vnM
Yes ❑ No
Is Ihe P�oPertY in Queslim: MmiaDy ASSe55ed
❑ Rea� P.ocem ❑ amn,a�y nssessea
D'siricl? Has Nis de0uoion
for wrtent yeaR
COUNTYAUDROR
20 _ 20
Counh 0 �.
r�
iled on p�oprny
Yes ❑ No
Date (rtunth, daY• Y��
20
intortnalion is W e and mrrect arM that the applicant is a resident of tMiana aM
ion is filed.
oare (monrn, daY. YBaA
� � �—��.
o� (�,�mn,, aar. rea�