HomeMy WebLinkAboutMortgage_Akin"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fortn 43709IR77 / 6-09)
� f Presaihetl by Departmenl of L.aml Govemrtrent Fnance
IB
wsrRUCnoNS: qpm�I
7o be filed in person or by mail vnN Ure CounryAuditor or Counry RecoNer o/ Ihe county where the property is focated. J C �
F7irg Dates: i) Real Pmperty: Mus! file during the year /or which the deducfion is sought Auditor
2) Mo6de / Manufactured Homes rat assessed as Real Pmperty Must fiIe danng the tweNe (72) months C. ,
6e(ore Ma�ch 31 of eacA year Ne Aeducvon is sought. �
See reverse siCe foraddi6onal instructions and quali�catrons. UNTY AUDI
M�ryt,(owneraroond-acbuyer-syre�� reverse//e) '1„_ � D . .
// , n t/ n
Key numCer I legal desaip' Record numEU Page num
aG-/ - - 3�l-000. vaS-o1.� 0 ��8
f mal poperty as of Mortpage / Conbaa iMehteE�s unpaid az U Mongage / ConVacY intlebtednrss unpaiE as d Is ihe aPF��i Me sole
year March 1, a�re year date of appfmation Iegal a equita6le owneR
a ❑ Yes ❑ No
l lrer amd share ot interest? if owned with somea(re dher Ihari spouse. mdrafe with v.trom
II �me an reco�d is dil
Name af rtiortgagee or
Iddrea�
Name ot assignee a o
Aatlress�assignee (i
a cantraa seAer lnurtFer e�a sveeG �Y. state. arid La code) __—____
awner
spee4 ciry. slate, and Z/P
Does ap�nl own property in any oNer I I( yes. whal caunt�/1
�,�r �� i��?
❑ Yes ❑ No
20 � 20 _
I I We certify under ihe penalty of�
owner / mntracl buyer of ihe aforer�
� `.
renue(qwn fiN�me �
� F�A resfident aEdfess of appGCant (num6er �
� Y.J
Pasm auNOVSO Oy OuA' ezewteO Power
AderessofaWior'vedperson (numberarrc
[i9
1
Is Ihe P�DeRY in Vuestim: Mmia%Assessed
❑ Real P'operty Q Armually A55essed
D���,,.�.�.io.ao�l...:..... -
YMatTarirgDi ""7��� 1 , � : —
1
�O
� 7, �. ��i .:.... . . No
20 I 20 I 20
Da1E (monN. Eay.
�
that the a e and toregoing informalion is We and cortect and that Ne applinnt is a resident of Indiana arM
ned prop on date applicalion is filed. �
Date (month, day, yaar)
� Y' -� �i rc�
IC G7.142-0]
slate.
�ate (rt�onth, d�: Yea�
7