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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
' • Smte Farm 43709 (R71 / 609) g
�' ' P�esaibetl M �eVartrtrerd a1 Looi GovemmeM Fuanca � p
Iw � ile Mark
wsrRUCnoNS:
To 6e filed in person a by mail wiN tAe CountyAuditor or Counry Remrder ol the counry where the pro (�(sl�t�j Form m�
F17ing Dates: i) Real PropeRy: Must file dunrg fhe year for which Ne deduction is sought �Y K 1 3 L� �� Counry Auditor
2) Mobr7e / Manufactured Hwnes nof assessed as Real Praperty Must fiie dunng Me hvelve (12J rtwnths ❑
6efae Ma�ch 31 of each year the deduction is sought. C� r� Counry Recarder
See reverse side for adtlitional inshuctions and qualifralions.
Appfmnt ror�b -searashim'ms�rere e) g COUNTY
C
- Key � kgei aucioua, aewb aa9e 5
�- a-os-3oo-aoµ. S -oa �
AR¢sed rnal poP�Y M A1p�q�g e/ Contraa 4de6ted�s unpaid as of Mort9age 1 Con:ra� cWebteMrss �mP� az M Is Ne eGP�t Na mk
61ard� 1. onrn[ ym Marrh 1. wrtentv"�r�4y� ^^ date ot aGP�� �� eW�� �^T�
"' I O O W ❑ Yes ❑ No
tl n0. what fs his / her erad shara of inteiest? If owned with sommrie oG�e.r Ihan spouse. mdrste with M�mn
It �rne m mmd 5 Qrtferent ttun tl�at o1 aPP�t bdka0e bebM' I5 U�e pmperty in QuesUm: MnuaP/ Asussed
O�!�nv D�+�N�
e.udle�-ame �c��.�-�
Name W mort9a9ee or contrarl seAer ,'
Mdress W nqr[ga9ee ar wntrad se0er (number e '. sbfa. anE cade ,
Name of assignee w other awner or holAer of mMgage / •• _
PilE25sotassignee(numberarMatreet,ary,5late.endZlPCOtla) "_ �- �"�
Dces aPW�mnt o�rm V�PeNY in any aher If IRS. whal countyl -N .. �� _/ � I, •' •••• � �.ted m O�Y
munryinlnd'ana? ❑ Yes ❑ No ' �O•.•CT �e5
Dra���er -� ❑ r,a
3 S ��
couNn . • • • '
DeducCOn approved'ui the amount ot Car d� �•... •/1\
20 _ 20 20 _ 20 _ � / �/1� � " . 20 _
«�
Sig o ' r Cc...�y Date(nrmth/lay, Ir� I�
U �3 -
1/ We cert'rfy urWer the penalry f perjury thal Ne a e and foregoing intortnaGOn is We and cortecl and that the applirant is a resident of Indiana aM
owner % contract 6uyer of the atarementioned property on date application is filed.
' faGUe (oxneh f� name) � Date (monN. EaY Y��)
L
FiID resEent U a ' t(num8er anASLaet �Y. �te, entl LPmtle)
7 w � Qr;qccibn XN �/�G7�
aufhw¢eE Gy dWy ezewted PowrJ of AtmmeY a bY IC 61.1-12-0.7 �� (�W. �1; Y��
lddress of aullror¢ed pe+son (numberarM 5hee1, tdy. S�te. en0 ZIP rntle) _