HomeMy WebLinkAboutMortgage_Belcher�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yeat
FOR DEDUCTION FROM ASSESSED VALUATION
S�te Fortn 93709 (R11 / 609)
� � PresaiGeO �y DepartmerR d Lmal Govemnnrd Finance
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INSTRUCiIONS: F � ,
b be fiied in person or by mail with the CountyAuditor or Counry Recorde� of the county where the prope is . �
Flirg Dates: 1J Real Property: Must hle durirg Ne year fw whicA the detluction is soughL Counry Auditor
2) Mobife /Manufactured Fbmes rat assessed as Real Property: Must fiie dunng the fwelve (72) monfhs
eeto� Ma�u, si or B�, ye8� ma e�a�,�.r�o� ��nc MAR 0 8'�1 1Uca,�ty R�.a�.
See reverse side 7or addrtional insMxtions and quelificafions.
ADPlcaPf'WY'^ai°rcor+7artbuyer'��9P^?mreverse/�/°) . / `—vrr /I.(.��.
L - til:w —iv— u —
A4¢sed vaqie U re� popeM1y es of ' Mortgage/ Contracl 4debteEnac
MarU 1. nrmV year March 1. aurent year
If no. what Ls his / trer era�y shara of interest?
If rurtre m �emrd o Q�tferent Nan ihat ot a7P6cant'oWipte Debw:
Name ot rtnrtgagee or mntxl seiler . /1 n %1
Addtess of moM19a9ce ar mnbatt
awner w halder N mortgage
e�c fo-eec �r.
Does e�itant ovm property in eny oUer
munty m IrWaru? f"l .,_"
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cil�; srate.
appOption
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Is Ihe ap i ttce sde
legal w epuitade owreR
❑ Yes ❑ No
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COUNTYAUDROR
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Counry
Is property in QuesSm: MnueDy As,u55e0
rx� ProPerty ❑ nr�,uany w�sed
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I I We certity urWer the penalry of perjury Mat the above and foregoing intormalion is we and correa aM that the applicant is a resident ot Indiana antl
owner I mntraU buyer of Ne aforementioned pmperty on date application is filed.
m�u¢ (oxneh h�tl�flmaY� _ i Date (rtrnN. daY. Yee�
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ard LPmtle)
o(Attomey w Dy IC 61.1-12�.7
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P4drass of xWior"¢eE prlson (numeerentl snaet �: sbte. ana t/r cotle) .
_ I Date (month. tlaY.Y��