HomeMy WebLinkAboutMortgage_Mull'�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
. FOR DEDUCTION FROM ASSESSED VALUATION
s�e Fo�„ ea�oa �Ra i za��
`' ,.,, � Presrnbed by oepanme�ri or Local co�emmern Firw,ce
INS7RUCTIONS:
To 6e filed in person a by mad wrth the CourrtyAud'dor dthe courtty whe�e Me prope,(y is bcated.
Fd'arg Dates: i) Real Property: During the 12 monUis 6e%re Jwe if of the yae� the deduction is to be e9ective.
2) Mobile Homes assessed u�Mer IC fal. f-7: Behveen January 15 and March 2 of Me year the deduction ��fe �'fe8ti� 09
See reverse side /or additional insWctions and qua!'rfications.
ree
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alue u rral as or Ma�d� 1. wre�n reer MaApage � coniraa ineeweanass unpaid as af Marcn 1. �s u,e appGrant u» �ega� «eq�ri�awe wn,en
airterrt
❑ Yes ❑ No
is �a / her exad share af irrterest7 If owned wilh sommne alher �han apouse. �cate wifh whom.
If name m recad is diRerant ihan
Name of rtartpapee or conUaG se
mo�agee n oonvaa selkr (nwnnarane s6eet dry, stare. end
Name of assgnee a alha owner w hdder
naa��ss or a�vy�
oces aawKara v«„ ro�nr �n ary wne�
coumy in �ndana9
❑ Yes ❑ No
Deductbn approved in lhe amount
�
SignaWa at Counry Autlilnr
�
I/ We certify under the penalty oi perjury
Indiana and owner at ihe aforementirned
; af applicaN
s-a�. .... , .,,��
ececvted Po+.e� dP�ttaney m hY
Is Ihe property in questim:
❑ Real Property ❑ Moble Hane (IC 61.
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Addr�s M aulha¢ed pasm (nurtrber and sGae4 fdy, sfate. and LP code)
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www.tylertech.com
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❑Yes ❑No
20
� �Y•Y�A
`is / were a resident of
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Daie (mmlh. day, yea�