HomeMy WebLinkAboutMortgage_Gerts.>°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
s�a r«,� ea�as �r� i z-0»
S„w � Rcsmbed M Departmenl of local Gavemment Finarxz
♦
INSTRUCTIONS: �
To be filed in person or by mad with tlte CountyAuditor ol the counfy where the property is locafed. _ _
Fd'urg Dates: 1) Real Property: During fhe 72 months belore June 17 of the year fhe deduction is fo be effactive. ' .
2J Mobile Hortres assessed under IC 61.1-7: Behveen January 15 and March 2 0! the year fhe deduction is to b� e�eadi8e.
See 2verse side )or additional instr�ctions and qualifications. O`� Q�� Uu ,.
ApqicaN (owne ar lrarl 4vyer' ;ee re" reverse si/! - `` 'i .:», .��'�°'i1'
��L��%�/i��t���'�t«
Yr6
If reme on recad is difFererq than Ihal of applicanl, inAinte be�o+r
Name of mottgagee or mMrxl seller � �� .yy � /�/�
Address of mortgagee or oon4ad sdler (num d straeG dty, state. and LP code)
_� --
Name of asspnee a olher oxner or hdder d mori9a9a
city, state. arM ZIP oode)
applicaN o.m properry in arry oiher
y in India�T
❑ Yes ❑ No
�s u az of March 1,
�UO
If oxned wGh mmeone W
Ta�dng Disiricl7
i. =-
Is 1he
T,�
%e Iegal or equltaae oxner
❑Yes ❑No
spouse, mNCate wiln whom.
Is Ihe property in Question:
❑ Real Pruperty ❑ Mobile Horne QC 61
Hes �his deductian been requesletl on property
fd artent yea/1
❑ Yes ❑ No
, � ... COUNIYAUDROR
oeaW . ��r�
Drawer NO.. �"h!`"....
�
333�5 ` Zo — Zo Zo _
� .......... �,�
Card ��• ...........^G\
SignaLL ��� � y,/I . olJ� Date (manlh. CaY•Y��)
1
I/ W __ _., ..�tier tne penalty of perjury ihat Uie above and fwegoing infortrwbon is We and correci and tliat Ihe appGcanfs was / were a resident of
Indiana d ovmer of fhe afwementioned property on March 7, Nl
Sigra4u e(s M name) _ � Daie (manfh. daY. Y��)
�:sitlenl atldrass of applin�num6er and s6ed. aty, sfafe. aiM ZIP wde)
�� �S Tir2 iieY (h�� Qr tFor+-Brc�� <.L.
Persvn authwaed by duy enewted Power of Altorrrey or by IC 61.7-12-.07
AddrPSS of aWtur¢ed persan (number aM streel. U}; sta(e. and ZIP ootle)
•