HomeMy WebLinkAboutMortgage_Hary' '� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
s�a Fam anos �as i 2-0��
�� � Rcsaibed by DePartment of Lacal Govemmenl Firiance
�.r
File
INSTRUCTIONS:
To be fiied in person or by mati with the CourrtyAuditor of the courMy where fhe propeAy is located.
Fd'mg Dates: 1) Real Properfy: Dunng the f 2 months be%re June 11 0/ Ure year (he deduction is to be et/ective. ��oOn
2J Mobile Homes assessed emder IC 67.1-7: Behveen January 75 artd March 2 0/ the year the deduc6on is t��/fec � 7
See reverse side (or additional ins6ucGons aM qualificafions. .
(owner d�7ad Wryer - see
/legal
side)
numbri
'' ol. 25�i � 0 0 i
d March 1, wrr�d ymr Mortgage / ConVaC uWebtedness unpaitl as M March 1, Is Ihe �canl lhe sda legal or e[ryritahie owneR
wRenlYear /� �
N ❑Yes � No
of mleresl? If ow�red wiU� sortieone dher Ihan spouse. ir�d'icate with whom.
reme m recard is diBeteM Ihan �hal a( applinrrt, indicate below:
Name of mortgagea or oonUact seiler
Address a moM1ga9ce u mnLaa sellet (nurrtber and �rcet dry. stafe.
Nartre of assgnee or alher w+ner a hdtler of mortgage
Address of assignee (rurtn6er and sGeel, aty, stafe, and ZIP cc
Does applicard ovm property in arry other If yes,
county in Indiana?
❑Yes ❑ No
DeducUOn app�oved in the amwnt of:
�1����
D�-z,���,� �io. 0.9. -..3./..�..
� /
C 11' (1 1�` � . . . . . . . . . . . . . . . . . . . . . .
20 I 20
Counry
Is Ihe praperly in queslion:
❑ Real PropeAy ❑ Mobile Horne QC 61.
ias Utis dedudion been requesled on paperty
a artent yeaR
❑Yes ❑No
20
yea�
20
I We certify under the penalty of perjury ihat the above and fwegoing infortnation is true and correct and that the apptinnts was / we2 a resid�t of
idiana and owner of ihe aforementioned properly on March 1, 20
rauve (owners I�r� name) � oate (mmm. dar. v��
� f ap�unbe ,and s eL cpy. sfafe. Z P cotle)
i�i �.� w.�a�
by duy ezeated Pwrer of Attaney a by IC G1.1-12.07
Addrrss of auihaized pe�san
1
��..�.�'r� � �'?fi 7 D
--f Vate (mmGr. daY.Y�n