HomeMy WebLinkAboutMortgage_Bodrie""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Stata Form 437W (R10 Ht-0B)
` , Pmwibed Ey DepaM�ent d Loral GovamrreM Finance .
To beRfiletl in person or by mad witl� the CovNyAWifor d fAe county where the P�oPBKY is bcated. � JL �a� �
tiling Dates: 7) Real Properfy: Must Poe dunng Ihe yea� for which the deduclion is sovght. J� a�� �,.��
2) Mobde /Manulactured Homes not assesse� as Reel Property: Must file durirg tl�e tweNe (12J mmfhs 6efae March 310/ each yea�
fhedetluctanissought. JUL �. 2009
See ieverse sCe M addAional inst�uctbns and qualifications
•! J/ ���Y // a��/1l//1 i e�>� O�/4� N�
AssesseC vape of r�l poperty as d
� i. �m yea
ro. wnat ¢ ho / ner e�ad
H `ame m
� i �
Alor�qage I CaNrx! fidehledness unpaid as d Mangape / Conirad indebtedn unpaid as d Is lhe applimN Ihe sale
tAamh 1. pmeN year . dale of appGcation �YY� I u epuRable owie(r
/� bA4J � ❑ Yes ❑ No
M avned with sortreorie aher Ihan sG�, indrate wilh wlwm
. u,akate cabr. � Fs a�M � a�,estia,: nnrauM assessed
Real Pmperly Q MnualtyAssessed
/l MoGle Home (IC 6-1.1-i
Name d ma�igagea or coniract seAer � n
�� l�
Addtess of rtnrt8agae or mntad 5e0er (rumDCranO sG
Name d assigrree w olhar owner or MNar N mo�igaqe
Pddress d ass;g�e (�ww�r anC zhecl, mY: jp�, and
Does a
m,my
�
praperly in any othar
❑ Yes n No
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tilY. sj4�, and LP code)
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� I 3(�, 553. c� , _,
I/ We certify uMer the penalty of perjury ihat the above and foregoing'v�fartnation is We and cmred and ihat Ne applicant is a resident of Indiana aM
owner f mntract Wyer of Me aforementioned property on date apPtintion is filed.
7natura (o.nids t� nanre) "'' _ ` Oate (manN. OaY• Y�"ar)
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Parsm authprzed by Euly ezawbd Pwer ot
parson (numbe�aMStrtrot,tily.stalo.andLProEO)