HomeMy WebLinkAboutMortgage_Falls"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C" n s' Year
,.__ FOR DEDUCTION FROM ASSESSED VALUATION
• '. � State Fwm 437W (R71 / 609)
S..,. � Presaibetl by �ePaRmeM of Loral Govemmenl Financa
26�1¢ Ma�c
�NSTRUCTIONS:
To be filed in person w 6y mail wi[h fhe CounryAUditw or Counry Recorder of the counry whe2 Ihe property is lo at�. �� ��
Filirg Da[es: 7) Real Pmperty Musf file durirg the year for which fhe deducLon is wught. � Counry Auditor
2J MobBe / Manufadured Homes not assessed as�R'e�ahProperty Must file during the hveMg,���7r�thdUNT q��unry Recorder
6etore March 31 oleach year fhe deduction is
See reverse side !or additbnal instnations and qualfications_ �
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KeY nunber / legal desaiDtian
��S ", 3 U. 7' W L
� / Contraa indebteCness unpaitl
wrtem vear . ..
If name on remrG is tliRerent Nan Nat of apP��t �d'uate bebw:
Se9er
wntract se0er (nwribcr antl sbee4 �+ry. state, ard ZIP code)
Name of assignee or oprer owner or
.naaress oi assgnee (numner am suee; rny, stare. ana tir cme)
Does apdinnl wm praperty in any other
munty in IMiana?
, ❑ Yes ❑ NO
20 I 20
rt yes, wna[ munry!
COU
20 20
I Cantracl
h Ne app6mnt Ne sde
kgal or epuitade owne(!
❑ Yes ❑ No
ovmed wiN someorre dher ihan spouse, indinte with whom
Ihe p�operty in 9ueslion: Mnually Assessed
3� �aenv ❑ a,o�y a5�ss�a
�1'�1YCY,1�`�....�0� �.
Ca rd 1\'O. ...' , S�
�%8,4�. oo....
AUOROR
Counry
p— � �—
Date (manfh. EaY. Y��
� P�Y
20
I/ We certify under the penalty of perjury that the ahove and foregoing infortnafion is true and mrtea and Ihat the applrcan[ is a resident o( IrWiana aM
owner / contracl buyer of the afwemerrtioned properry on date applicatlon is filed.
�nature�ovmeYS lull neme) � 0 , Dare (rtemfh, day, year)
Fun revaent a0dress ot appiicant (numDer ar�e shaet, tiry siata antl ZIP op
� /D `/ �S' G<JQ�.%it/> .��/�iceuce
Person auttror¢ed Cy Cuty executetl Power of Atiwney or by IC G7.1-12-0.7
Pdtlr�s of auNOr'¢id perwn (number anO.W eeC dty, state, and ZIP code)