HomeMy WebLinkAboutMortgage_Hughen"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
' T� �� Sb[a Fam 03709 (R11 / 609)
� �.�. � Presaibed by DepanmeM of Ldal Govemment Fnance
� .� � FiI� �
wsrRUCnoNS:
F«,�, ru - y //
To be lled in person or by mail with the County Auditor or Counry Rewrder o/ the county where the property is located. � � �/
Filim� Dates: 7) Real Pmperty: Musf file durirg the year lor which the deduction is sought. " County Auditor
2J Mobile / Manulactured Homes not assessed as Real Property Must file dunng the tweNe (12) months
be(ora Malch 31 oteach }rear Ne deduction is sought. � O Q�.� ,�ry Remrder
See reversa side lor adtlilional instmcLbns end qualifrcations. ._ . � �
AGPGUnt (o or a - see re�kGOns on reve " 1.. _ n �%%7,.,� .�h_6-q
If Iro. xT2i IS Iti5 / tIM CiaGi 51�218 O� VItE
tl nartie m remrd'e Eitter�t Nan fhat a
Name ot mxtgagee a mntraU se4er
Pddress of mongagce or mntratl seder
Name of assignee w aher ovmer rn hd
AAtlress of auignee (num6er entl svee
Dces eppliptLL ovm property in eny oNt
munry in Indana? ❑ Y2s
Deducaan appiw�.�d N Cm amounc of:
me�ce oei�
VIIJ v�.�...�........
4- I-000.(�l -0a7 �F�i j
debteEness unpaid as of Mwigage I ConbaG'ui7ebtedn�s unpaid as d Is Ne appGmnt Me sde
tlate of appfifation ' legal w equita6le oxnM
7j3 ❑Yes ❑ No
IF awned with sameorre other ihan spouse. i`dircate with whan
IS CM PQrtY N QuC511011: Mf1Ud0Y ASS2SS�
ea� Propeny ❑ amualy ws�sed
S 13 �,,�,�`1•�_
rer end sLSe4 �1: sta[e. aM L code) ��� 1'j�,� %��
�1
mortgage
stete. entl LP cadel � q 1 J
It y�s. whac munt/+ � \ tledumm been requested on property
1 d�l )�� I. �� ���n ❑ Yes ❑ No
No
20 20 ' 20 20 _ 20 20 _ 20
�� itor Caunty �ate (rtnNh. daY. Y��
I/ We cerlify undel ihe pe ty of perjury that Ne above anC foregning infortnation is We and correct a� Nat the applinnt is a 25ident of Irdiana ard
ovmer I contract buyer of Ne afaeme �on property on date applicauon is fited.
�rianire (o fs M me) Date ( . daY lea�
� - / /�z. %a 4
n�ae�c aeaRss a a nt (numDer an0 . dry, state, aM LP coda)
w 1787 Conco�d
Person authometl �y dWy exewted Po
Pddress ot aW�a'ved person (numbe� aM sbeel, cily, slate, and LP ootle)
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