HomeMy WebLinkAboutMortgage_Holden^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__.. FOR DEDUCTION FROM ASSESSED VALUATION
• State Farm 43709 (R71 / fiW)
S y,� � Presaibed by Departmenl 01 Lowl Govemment Frence
File ark
INSTRUCTIONS:
m
To be �led in persan o� by mail wifh fhe CoanryAudito� or Counry Recorder of the counry whele the pmperty is located. '�' �
Filing Dates: 1 J Real Property: Must file during the year for which Ne deduction is so�qhL � Counry Auditor
2) Mo6r7e / ManuFacNred Homes rrot assessed as Real Property: Must file dunng the twelve (72) rtanths C��
6efore Ma�ch 37 of each year the deduction is sought ( unty Recorder
See 2verse side Iw addrtional insfructions arW qualificatbns. G i BS 0 N COU NTY AU DITO R
Appficant(o�meroroontracl6vye�-see mrevermsife) � ... � /
Key rvmber / legal desaiplion �'
a�•o�r- .� - o�-
�1pr(�ge / Cantract'cWeWe�n¢ss ui
Mard� 1, wrtent y�ar
tt ia. what's his! her eud share of interest?
If name on RmN ¢ diRe�m[ than Nat of aPW��4 ���te oelavr.
rya�y p} �gag¢¢ or mnVaG seller /n•- ^ ✓�
���� V�
Address of mort9agee w canbact snAer (number aM stree{ ci(y; state, arW
Name of aci�ee or other awner w halder of mwtga9e
gnee (number aM snee4 mY. sb7e. e+a
sF �- i -i�
own prppnny in any alher
�' ❑ �
❑ Yes
tluction approved'm the amoum m
20_ p_
��ahne d Ca�mb AiMitor
C . T' v�.�
I I We certiry under 1he penalt
owner / contracl buyer of the :
0 . /Glo— �1
i az W Mongage I Contra�Y'vMeMednrss impaid
date ot appliption
v
If owne0 wiN someone other ihan s , i�Micate
0
I mimba Page numba
9 � �-
as of Is Ne appGrant Me mle
legal weWtta6le uv.me(!
❑ Yes ❑ No
PenY in 7uesUOn: MnuaM AssesseE
�ovenv ❑nr�„�,�nra�a
reoa� r+ort� nc s
a �• � ° � L No�EV ��rrHL� �
I count/7 Whal Ta�d(g D'atr'v3
��73�,x�.+ T
20 I 20 I 20
��z,aqd�
:-r:rr :"+n
that Ne ve arW toregoing infortnalirn is W e and cortect arW that the appGCant is a resident of IrMiana aM
ned pro rty on date appliption is filed.
Date (monfi. deY. Yaa�
FWI msidenc address of appGrant (number antl t. dty, state, entl ZIP
155b N ID� l,� • �jon � l�
Person auUro�aetl by Cuy e��eewv.d Fowe� o(Anomey a by IC G7.1-12-
AOCmss ot aWmf'ved 7�^ (number antl street �: state, anA ZIP m
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