HomeMy WebLinkAboutMortgage_Miller (9)°^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun " Year
_ FOR DEDUCTION FROM ASSESSED VALUATION ���
s�a F«m aa�os �Ra i zd»
�' � Presmbed by Departmenl ot local Govemmerrt Firence
2 �
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INSTRUCTIONS:
To be filed in person or by mad with the CounlyAuditor o/ the courrty whera the propeity is bcated. —y�la ��
Fd'vig Dates: 1) Real Property: During the 72 rtronMs be7ore June 17 W fhe year the deduction is fo be elfectiva. //'
2) Mobile Homes assessed urMer IC 67J-7: Behveen January 15 and Marclr 2 of Me year the�/��y�� `sO�be �e,fl� TOR
See reverse side /or additional insWclions and qualifications. N T
i��ICN�Yl18�Q LiI(lil3t� bUyB! - SBB IB�IwilU�S 02YCOB/SB SIf�B�
� A� ralue M real property as
/ her exe�Y
iegal description
_ � t�- a�o -cbo. U (�,� -oa
� ��������s��ffi�r��
If ipme m recold is dillerent than Ihat of applicant, indiote below:
Name of rtartgagee or conUacl seller � �
Address ot moM1gagee or mnUaa seller (number and.4ree4 dty, sfafe, and LP co0e)
Name of assgrree ar aU�er owner a hdder of mwigage
Address of asv9�e (rcmibe`arM sUeel cily. 4ate, andLP code)
gpplicaM wm property in am/ dher If y
y in Indiaria?
❑Yes �No
ction apprwed in ihe amwN of:
20 _.. 20 20
wilh mrtieane
Whal Tazing DisUict�
)UNTYAUDROR .�
20 20 _
1/ We certify under the penalry ot perjury Uiat ihe above and foregoing infortnation is tru
Indiana and owner of tl�e aforementimed property on March 1, 20
FuTr¢5deniaddress o/applicaM (num6ei and street dty, sfate. and ZIP co0e)
�l 5 35o cJ �:�c.(oK /d/ '1G10
Person authonzed by tluy eneated Power oflutorrrey w by IC G/.1-12-.07
Address of auttnraed pasm (number aM sLee; tlty, sWfe. antl LP code)
Recard munber � Page number
�s u,e appfican� �he sda �ega� or emrilade wmtr:
❑Yes ❑ No
spouse. indicala wifh whom.
property in queslidf:
�1 Property ❑ Mobile Home (IC G7.
Has Ihis d�
tw wnent
r�
uestetl on properiy
❑ Yes ❑ No
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