HomeMy WebLinkAboutMortgage_Fritz__ry5TATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ownship vear
; FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fwm 93709IR71 / 6-W)
, Presaibetl by Departmenl oi Lnfal Govemment Fnance
File Mark
wsrRUCnoNS:
To be h7ed in person w by maii with the CountyAuditor or Counry Recorder ot the county where the property is located.
F�Nrg Dates: 1) Real Property: Must file dunrg the year (or which the deducfion is sought.
2J Mo6ile /Manufacfuied Homes rwt assessed as Real Property Mus! file dunng the tweNe (72) months
be(ore MarGr 31 of each year Ne deduction is soughf.
See reversa side lor addifional instructions and quali/lcafbons.
Appfmant (rymer wcontrad 6uyer - aee�shjrlions m rererse side)
Distrirl - Key nm r legal desaiDtion
� a(, - a-�� - ao -cr� l. S/ �- o a,
ed rahie of mal proper,y az d hbrtgage / Contract indebtedness unpaid as af Mortgage I G
1. ar�art year MarC� 1. /wrtMe�rt Y� datc of aPP�
�(�WO
Rut is his ! Icer axact share of interest? If owned with someorre
Aearea c
Name ot a
AEar�s of
Does applic
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DeducGan ap
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Remrd num
G in0ebtedness unpaid a of
�r than spouse. iMi�te with whc
'__ Is C�e Woperty in Questip
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Counry Auditor
b� Page numbnl
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Is Ne eppHont the sde
lega� w eWitable ovme(7
n Yes n No
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I/ We certrfy urWer Ne penalry of perjury that Ihe above arW foregoing infortnalion is We and correct and Nat the applinnt is a resident of IrMiana and
owner I contraG buyer of ihe afaementioned property on date applinlion is i�led.
Ina¢ua o mers hA namf) /1 � Date (monfh. daY. Y��
F�A resiCent address ol app(rant (num6er antl s �; sfate, anE ZIP oode)
� S�y GKee��'el Rcl �vRus
Person auttrofaetl by Cidy ezeaced Pawer of Anuney or Ey IL 61.1-12�.7
Mdress of authorrseO ce�
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