HomeMy WebLinkAboutMortgage_Miller (4)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__„ FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fortn 43709IR71 / 609)
� w» l Presaibetl by DepartmerG of Local Govemrtient Fnance
�NSTRUCT70NS: qor��e,rm
b 6e filed in person w by mad with tlre CountyAUdROr or County RecoNe� o/ the county where fhe pmperty is located. MQ,R 1 J Lu i C�
Filirg Da(es: 1) Real Property Musf hle dunrg the year hu which !he deduction is sought Counry Auditor
2) Mobile / Manufactumd tbmes not assessed as Real Property: Must h7e dunng Ne nvelve (12) monthsC �
befora March 31 of each year the deduction is sought. uMy Recorder
SeereversesidelaaddifionalinsVUUbnsandqualifications. _.___„ �,,,,,,_„ ,,,,,,,Tno
"_ resmcmns m mverse
Tav ism,l Key nlFber / legal tlewiptlm R¢m�y ruim6er Page numOer
a�,� a�-�z-i�-�oo-000. Y9�-ox? ao�! 9 G
Assesssl rehre d mal p(operty as of Mortgage / Contract'vdebtedness unpaitl as W Mort9age / ConvaU'uWebtedr�ss impad az d .Is ihe aPP��� �e sole
MarM 1, qnent yPar Mart� 1, artent yeer date a( applimtion � legal m eputtade oxne(!
� OOD ❑Yes ❑No
11 �ro, what is his / Mr exar2 share of interest? It owned wiN someone dher ihan spause. md�[e w'nh wl�n
If name on r¢md ig Aifiggft Nan �hat a( appfiCant, i�WiCat¢ pebw:
Nama of rtangagee or mntraa seller
AAd2a U rtiort9a9ce w contraa seAer (num4M1r aM shee; city, state, aM ZIP cade)
Name of assignee or othu ow�rer or tmlder o( `mrt�age
MCres� of assgice (number aM stree4 mK sfate. end ZIP code) .
P ��� E N a
Does eppinN own poperty in any dha If yes. what wunCJ.�
muMy in IMiana?
❑ Yes ❑ No
Ction approved In ihe amount oY.
20 2q 20 20
i0$ 8,4 C
VYhat Tapm� Dislrirl?
Fi�7
DI':1\1'CI" ��...�.�.� I .
Card NO. .. �.��P�
.................
I �-I 7,150. c�
Has �ha tleGr�im Eer1� rWuesteE m P�Y
� d�� �n ❑ Yes ❑ NO
F��:
�'1��
I I We ceru(y under ihe penalty of pe�Lry ihat Ne ajf6ve and foregning infortnalim is we and cortect and ihat Ne applinnt is a resident ot IrWiana aM
oxmer I contract buyer of ihe aforementloned propf.�rty on date application is filed.
� 9 (owne/s fiAI name) Date (month. daY. Yea�
ull of rcantn beraMSfreet,' te,anCZl e)
Y1C.e��D �D O
Per..wi UpnzeE Ey tluty ezewteE of AltomeY m Dy IC 61.1-12-0.) Date (rtronfh, dzY y8a�
Pddress of aiNror¢ed persan (number arM sbee( dry, state, antl ZlP ootle)