HomeMy WebLinkAboutMortgage_OKeefl^�� STATEMENT OF MORTGAGE OR CONTRACT INDE
FOR DEDUCTION FROM ASSESSED VALUATION
suie r-oim as�oe (Re � 2-0�
�' � PresoiDed by DeparMent d Local Govertme`ri Firence
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wsrnucnoNS � MAY 1 2 ��a'�
Te be filed in person or by mad wifh the CourrtyAudrtoiW the courAy where the properly is bcated.
fd'v�g Dates: 1 J Real Property: During the 12 montfts belwe June i1 07 the year the deducffon is to be elfective.
2) Mo6iie Homes assessed �mder IC E7.1-7: Behveen January 15 end March 2 0/ the year the deduc6�i
see reverse side �w add',sona� inswctions a,nd qualirmatio,u.
r.iwSON COUNTY AUDITOR
Applirant (amer m Ua Gyer'see resVicfions n bverse side)
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Taa isUid , Key number / legal desaipUor
-�
� rdue of real popaly as d Mart3i 1. arrenl Y� �5
a�rtmrt
If�•hat is his / het exaQ share af iMerest7
If reme m recartl is diHerent thmi Mal d applicar0. i��ale below:
mortgagee or cmiracl sellar
ot murteagea or mnvaa
Narne of assignea a
�i�ard orn, qopem �� ariy an«
i����
❑Yes ❑ No
�he amamt oE
mart9age
-Q06. %GF�'a�,
fct indeWedness unpaiC as of March 1
antl LP code)
If ownetl wilh sameone
cty. sF.-'- —('' �-�- - -
V �t'
_ � _� _ � J DITOR
�JC
— �
20 � 20 _ `
rture of Counly AudMr ��y� _ , n �•�nry
��\Q�,.�
number
�s me apacm�� u�e sde �egal w eyuiw�le wmen
❑Yes ❑No
spouse. indicate with whom.
Is ihe property in questian:
❑ Real PmceAV ❑ Modle Home QC E1.
Dt'a1�'Cl' �i�...�i%�'a' /
Card NO. ......�1.30 '^�
����,9����i.... ❑No
20 20 20
I/ We certry under the penally of perju� in is true and mrtect and fhat the appGcants was / were a resident oi
Indiana and ovmet oi the aforemenfione - -
SigrmLUe(ownefsMnar+a9L . . . Dele(mmlh.OaY.Y��)
z60
eWhor¢ed
Address of
applicanl (number and s!
1/- So 5. P�;nccf•��
Wy exeaned Power otamrney w by �
person (numberendstreeCUy;sfafe.
r 'y�ib-/FJ
1-72-.07
(month. daY. Y��