HomeMy WebLinkAboutMortgage_Sollman (14)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
7__ • FOR DEDUCTION FROM ASSESSED VAWATION
� StateFOrtn43709(R77/609)
�,,,, 1 Presa�nea q oepanmern ot tn�ai Goremmem F��nce
�STRUCl10NS:
To 6e filed in person a by maii with the CountyAUditor or Counry Recorder o( fhe aounty whe`e tAe pioperty is located. A �
F�"�i�
Ffig Dates: 1) Real Property: Must fJe during the yearlor which Ihe deduclion is sotghL County Auditor
2) Mo6�7e /Manufactured Homes not assessed as Real Property Must file dunng the hveNe (72) monNs C�
6efore March 37 of each year the deduction is sought. nty Recorder
See reverse sio'e for aCditional instrucGOns end qualifiwtions.
Anofxant (owneror oontracl buYer- see resfic0ons m reverse siiel
Key
- - - s�
p'aperty as of Mor(qage/ ContraG 4�de6teCness unpaid as W
Mard� i. artem ^year
i1e 1 . �ii�z1
at Is Ns / ner eraC share oi intrlest?
m remd is difte2nt Nan that of applkant, mCicate below.
Name ot nqRga9ee ar crntrarl seller
.� I 3
naa m nwrtgagee «ca,o-ad seo�
Name M assiyiee w othel owner ar h
Jimnl own popeny in any aher
Indana?
❑ Yes
Detluction appioved m ihe amount
20 _ I 20 _
Signanrte d Counb AuOitor
I I we certiry under Ne penalry o�
auNO�ee oy
zr eiw suee5 ary, sraie, arw ur ooae7
mortgage
state, aM ZIP oode)
i, res. �ma� wu�y.�
� No
COUNTY
20 _ 20 _
0 0� - o�
Igage / Contrad inEeb es
; of applkatan
somearre ahu Ihan spaae.
�
NTat Ta�drg Ustri[
�
RecoN numba Pa9e numhei
i a �a
unpaiE es d Is Ne epplkant the sole
kgal wF� ib�ble amefl
hlLYes ❑ No
perty in Questim: MnuaAy fv�sessed
ProGertY ❑�M�QI�Y�1.
DCa\1'Cl' 1�. ��•��•�.....
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Card \'On . .....................
�� W� i �' �
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ICounry I Date (marrth, tlaY. Y�h
the above arW (oregoing infortnation is W e and correcl arM that the applinnt is a resideM of Indiana a�M
properry on date applicatlon is 51ed.
Date (mm(h. OaY. Y��
���d' � hP�°'v%�'� `f 7� %�`
, ,�
or Dy IC 61.1-12-0.7 Date (monN, day, yaa�
person (numberaM stree4 yY. �re, antl LP cade)