HomeMy WebLinkAboutMortgage_Callis (4)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ ; FOR DEDUCTION FROM ASSESSED VALUATION �
s�e r«m aa�w cRi i i sas� p
�' f Prestri0e0 by DePa��ri af Lod Gm�emrtrent Fuance 4
,«• ��p File Mark
INSTRUCTIONS:
To 6e filed in persan or by maii with the CounryAuditor or County Recorder of Ne county where the pioperty is bcated. F� fl� �:
FiNrg Dates: 7) Real Property: Must file during the yaar /o� which the deducfion is mught. � Counry Auditnr
2J Mo6Be / Manufactured Homes rwt assessed as Real Property.� Must Ae dunng the hvefve (12) montAs
befo2 March 37 of each year the deduction is sought ❑ County Recorder
See reverse side lor addifional insNxfbns and qualificafions. .
Apaipnl�jGw�erwaqntradbu�er-see�sfi'rL'op5'�rire ey1 _ � g .
A�sed veLre d real poPerfJ az of
A/a�Ul 1. amnt yPar
aU
1( Iq, wh3t 6 h15 / htt ClfdO Sh3IB Oi If11HP31?
name m remrd's diFerent ihan Nat of aDp6rant,
rlame or mongagee «mnaac� sN�er
Aedress ot manjaqee «mnaaa un
Name of assignee or afhrJ or �
AACress o1 asvgnee (number antl sfn
- U�- . D/� -
/ Contraa intle6tetlness wpaid as of Mortgage I Co
airmm yrar date o( appG�
Gebw
ffire,
cdy; state, aM ZIP code)
Dces ePWipnt own rynperty in any other I If yes. what
munry in InEana?
❑ Yes ❑ No
�i O�Mfd WI(�1 SMI�WM OU18f
e
AUDROR
ness unpaitl az d Is ihe ap�mnt the sale
� legal ar eWNatle ownM
❑ Yes ❑ No
ae, udkafe wtrh whwn
� P�Ge+H in Oues6on: Mnua%PSSesseE
Reai a�oaenv ❑ a,ouanyaSSessPd
naaie frome pc s�.�-�
� � /'
: ,� �,�,a�o�°.a°o�.
�
_ ➢�a���t
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20 I 20 20 I 20 _ 20 _
Signature W County AuEitor Couny
Cal�\O• ••.
20 _
Date (rtronth, d2Y. Yea�
�
20 _
I/ We certify under ihe penalty of perjury Nat the above arW foregoing intomiation is We and cortect and ihat Ne applicant is a resident of Indiana arM
owner / wntracl buyer of the afaementioned property an date applicatlon is filed.
� �� n.JlNh.���B�U/ �i/%O� Date(monfh.daY.Yae�
FWI rer.ident address
sLee4 tlry, state,
Cy IC 61.1-12-07
Pddre� of aNha'¢ed Ve�+ (numberarM saee4 ury• sla(e, arrdLPCOtle)
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