HomeMy WebLinkAboutMortgage_Helm"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Counf
, FOR DEDUCTION FROM ASSESSED VALUATION
SQte Fam 43)09 (R71 / 6-09)
�' ..,. � Presmbetl �y DeparlrtieM o1 Lotai GovemmeN Finance
wsraucnoNS:
To 6e filed in person w by mail with Ihe CountyAuditor or Coun y Recorder o! Ne aounty where tAe property is located.
FiFrg Da[es: 7) Real Property: Must file dunrg the year for which Ihe deduction is sought
2J Mobde / Manufactu(ed Homes rat assessed as Real PmpeAy Must file dunrg the hvefve (12) months
6efae Maich 37 of each year the deduction is sought.
See reverse �iQe !or addifiuna/ instructbns and qualdications. n
AsessM raNe cf mal paperty as M
Mamh 1, anent year
If ro. what is his I lrer e�od shara Of interest'7
_ �lo— /O/—UO/.O
age/ Contrati'ude6tetlnrss unpaid as of
� t. wnerit yeer
tt rwne m rerrnd is dAferent Ihan that W app6mn4 md'xale Debr'
Nartre of rtnrtBa9re m m�tract se0er
��
hdder W nKVtgage
�Y.
Pddress W assgnce (numEer erd atreet �Y. stete, ad LP tade)
aM
tt awnad �viM
Year
Ni2f�C
S �1`��p�'�`
Counry Remrder
3 _ 6� � ?0 0 ��S
ageOl Cantraa uWebtederess �mv� as d � a�e o�+xl.+
a(f Q • � � ❑ Yes ❑ No
�meorie other tl�an spouse. iMifate wiih whom
Is Ne PbD�Y in VursSan: Mnua%ASSessed
❑ Real ProPenY ❑ A"^��Y �
MoWle Fbrt�e OC 61.7=.
I Dces e�i�aM ovm OroPertY in any other I It yrs. wha[ caunM I Wtat Tari�g Dstricl? I Nas ihis deductian Oeen re9uesttd on O�Y
munry in Ind'vna? (ar amm ynaR ❑ Ye5 ❑ No
❑ Yes ❑ No
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