HomeMy WebLinkAboutMortgage_Draper.w °'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T s ip Year
_ FOR DEDUCTION FROM ASSESSED VALUATION �
s�e F«m as�oe �rxs r z-0»
�' ;� r Prexnbed by Department of Local Govemmenl Finance
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INS7RUCTIONS:
To be filed in person w by mad with the CountyAud'�tor o/ the county where the property is loceted. "yi� ��
Fding Dates: i) Real Property: Dudng the 72 rtronths be%ve June 11 oI the year the deduction is to be elfecGve. v��
2) Mobi7e Homes assessed under IC 6-1.1-7: Behveen January 75 and March 2 o/the year fhe deducliqRisla�`e qUDITOR
See 2verse side fa additional ins6uctions aM qualifications. ��i6S
sae re�Gicti � reverse side)
Taurg Disirid Key numDer / Iegal desuiption
hssessed rehie af ieal popaly as ot Mardi 1. amenl y�r MonBage /(
airrent year
If •�.vhat is his I her exacl share of interest?
If iame m record is tliHerent Ihan
Name of mongagee or canlrsd seller (�
Atldress af mortgagee a mntrad seller (number and aheeG dty, state,
Name of assi9nea d dtier ovrner or hdder u1 malgage
Pddress of asvgree (number and sLee{ dty, sfate, anc
Does applicant oxn poperty in arry ather
county in Indiara?
❑Yes ❑ No
Deduction apprwed in Ihe amauM of:
�� p P —
Sig�ature of Caunry AudAOr �
as of March 1, Is Ihe appG�nl the sda legal w equitada rnvneT
❑ Yes ❑ No
If owned rrith wmwne olher ihan spouse,
.
Is Ihe praperty in question:
� Real Property ❑ Mobile Home QC 57.1
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— Dra�ser \'O. ��-...� y � �
If '� \• Has Ifus deduction bcen requesled on property
ro ' � ' . . t•�� fwcurtenlY�R
� � �� ❑ Yes ❑ No
— C�1'CI �i� . .....................
zo � zo � zo
Caunry
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Date (monN, day, yea�
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I/ We certify under the penalty of perjury that the above and foregoing infom�ation is hve and correct and that Ihe appli�ants was ! were a resident of
Indiana �n�ew't�r oi ih�rementioned property on March 1, 20 _ �
;����/ � � Date (mon(h, day, year)
pl' rrt n d s4eet. cdy. state, arW ZIP mde)
�1�"1'P✓i�tt.�l�f�K ��..c
erzewted Paver ot Ninmay w 6y IC 61.1-12-.07
of aulhor¢ed person (numbei aM sUeeG aty, sfate, aM ZIP oode)