HomeMy WebLinkAboutMortgage_Bent"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Counn� Township Yea
___ FOR DEDUCTION FROM ASSESSED VALUATION
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`,.�. Preaaibed by Depa�rt�anl of Lod CaoremmeM Firwca
ile
wsrRUCnoNS:
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To 6e fiied in person w by mail with the CountyAUditor or Counry RecoNer o/ fhe counry whera the property is located.
FiNrg Dates: 7) Real Property: Must file dwirg Ne }rear (or which the deducUon is so'ght. A G� Couny, p,�ditor
2) Mo6�7e / Manufadumd Homes not assessed as Real Pmperly Must file dur"vig Me twelve (72) months L U I(1
6elore March 31 of each year Ne deduction is sought Caunry Recorder
See reverse sde 7or addr(ional insfn�ctbns and quali6wfions. (a�� ��
A�essea raWe dreal P�P�Y as d
A18'dl 1. a+m1R yqr
It ra. what Is his I Mr euU share of interest7
If name on fecdd a tlilfe2nt than Nat of appl
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nCer l desc�pGOn O`7 — FCJ V. �(p10' � �/C � Page numbu
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R1ortpage / Contraa 4debteCness unPaid as W Mwigapa I Cort7aC iMe6teA�xss unVaid az of Is Ihe eGP�^� Me sok
MeRh 1, arRnt Y� Eete of aPP�� �al a W�ita6le ox�rt(7
�O ❑ Yes ❑ No
1/ awnad with someone oNer ihan spouse. IMipte riN whom
arR. 6Wifate Debw Is MoPe�i' in Cuesfion: MnuaDy Asessed
Real Pioa�v 0 �+�+�N �
Address ol nnrtgagce or contrac[ se0cr (nunba! ar
Name W assignee orp � e o a or hdQer�al rtnrt�
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neerPSS oi amqnee (nurn6er and sueec �r. smre.
No
Dr�uman apprwad 4i ihe amouH ot. �
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It yes. what munt)?
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� I I We certify under Ne penally W perjury that Ne above and faregoing informalion is
v.mer / contraq buyer of Me atoreme�oned property on date appiica0on is filed.
� Sqnaeue (orne/s NO+Isme)
, / F ' ent ' of appfirant (numbar a stree4 �: . � Z�P �a)
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Person autfnr¢ed by ENy exewreE Power of AimrneY � M IC 61.1-12-0.7 .
Addrmo/aW�avsOpersan (numberaMStreet,cdy.sble.enALPmde) .
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for wnent YeaR
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