HomeMy WebLinkAboutMortgage_Cunningham'�� STATEMENT OF MORTGAGE OR CONTRACT INDI
FOR DEDUCTION FROM ASSESSED VALUATION
s�e F«�, as�oa (Ha r 2a»
�' / Prasmted b7r Depertmenl aF �o�al Govemmera Fir�arwe
iNSrnucnoNS:
To be filed in person w by mad with the CourrtyAuditor d the courrty where the property is bcated.
Fdin9 Dates:2) Mobile Homes assessed,md� IC 6-11e7 Beuhveen�Jantuary 15 and reh o/theYeai th� uc6a1')sRb 6�e��
See reverse side lor additional �nsWctions and qualificafions.
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Assesmd vdue of real popaty as d Marrh 1, anenl ymr Mortpage / Conlract indebtedness unpaid as M MarU� 1. Is Ihe app5rant Ihe sde legal or eqiritaMa omieR
°'R�'�` 3 ..c�dD
❑Yes ❑No
If.•+ what is his / her eracl share oi inteiest? If ownetl wilh sort�eme dhar I1wi spouse. indicate with whom.
I�m remrA ia ditferenl ihan Nat of applicarp, in?mte bdow: Is Ihe poperty in question:
❑ Real PropeAy ❑ Modle Hane QC 61.
Nama of rtartgagea or carqraU sdler � I�
Address of rtartgagee or mnUad seller (number antl sbeet dtY. sfafe. aM LP code)
Name of assignae or alher oaner a hdder of marlgage
Address of assgnae (mm6er arM s6eet, dty, sfefe, entl LP a
DO¢5 B�IICBIII OMTI PfOQBfIY 1118l1Y OUIC( �( yB9.
oouNy in IndanaT
❑Yes ❑No
Has this deduclion been requas�etl on property
r« a,nent yesn
a Ye5 ❑ No
COUNIY AUDROR
Deduction apprwed in �Ire amount of:
20 �� 20 20 _ 20 _ 20 _- 20 _ 20 _
Sigretura of CountyAudGw Cwnty Oale (mon(h. day, yaa�
I/ We certify under the penalry of perjury that the above and finegoing informafion is true and corred and Uial the applicants was / were a resitlent of
Indiana and owner of fhe atwementioned property on March 1, 20
Sigratwe fWl name) Date (rt+mM. aeY Y��1
;idenl address of appliiaM (nwnber and �. sfafa. ald Z!P mda)
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P n aWhoraed by duy ezeated Power d Aqomey w by IC 61.1-12-.07 Oate (mmfh, day, yea�
Addr�s of aulhm¢ed person (numberarM s4ee; tYy, stsfe, and LP oode) � �.,
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