HomeMy WebLinkAboutMortgage_Jenkins (2)"`n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Counf
, FOR DEDUCTION FROM ASSESSED VALUATION
�• Sfata Fwm 43709 (R11/609)
, I PresaibeE by DePartmen� W Local Govemmenl Fnarce
INSTRUCTIONS:
To 6e filed in person a by mail with the CountyAUditor or Counry Recorder of the county where the D�PertY is focated.
Filirg Dates: 1) Real Pmpeiry: Must fde durng the year for which the deduclion is sought.
2) Mo6ife / Manufactured Homes rrot assessed as Real Property Must ne dunng the hveHe (72) months
before March 37 0/ each year Ne deduction is s[wgAt.
See reverse side lor additional insVUCfions arrd qualifications.
Aoobmm(m'rnerormntraeauver-seere.wcnmson sidel . ' N V�••.
G�g$O
Record num6er Page numha
ao 0
bteAness unpaid as o( Is Ne aPO�� Me sde
tegal w cquila�le owreR
❑ Yes ❑ No
spouse. indicate wiih vrtnm
51M WoP�Y in VuesUOn: Mnua�y Assesse0
�ea� RoPertY ❑ Mnually 0.ssessed
Mob�e Home fIC 61.7 �
A�essed vahre af re21 WoP�Y a o(
IAIa(U 1 mrent year
It m. whal Is his I her ezxt share ot interast?
I/ rwrie m remd is Qrt2erent Nan that ot app�
;Y9-/,,Sr-i0 /-oo /. /
Mortgape / Contraa inde0tetlrcess unpaiO as W
Mard� t. currem year rt
� � � Q� V
Name of rtnrtgageqj+r��baG seller
�/
Add(e55 ot �rortgegee ar mntrad 5eller (numbe/ end sbeel, cily. slBte, aM ZIP code)
Name ot assignee or ocher owner rn Iwlder ot rtortgage
AEEress of assgnce (number aM street tlry, state, antl ZIP ootle)
Dces applinm wm propeM in any other I! yes. whal wunry7
counry in IMiana?
Yes o
Oetluctlon ap in Me amount af:
20 � 20 � 20 _
If w�rreE wiM someore UMr Ihan
What Tadng D'¢tr
COUNTYAUDROR
20 I 2C
AudROr
___._
a01 �
DCII�\'CC �� ...................
.
c:,�-d �o. ...�g...........
� ►�5,750,�
_ i N_ I �
�naNre of Counb AuOi�or I Counry I oate (rtionN. tlav Y��)
I/ We certify under the penalry of perjury Nat the above and foregoing infortnation is We and cortect arW that the applipnt is a resident of Indiare arW
owner / mntract buyer of Ne afaementioned P�nY on date applintion is filed.
7naWre (ovy�hlutl nam�j /f / ^ Date (nniYh, day, yea�
ss d a icani (num6er£M sLeet, dry te, and ZIP oode)
ickasaw � g���C�. IN �`lb�
Oy d�dy ezeculetl Power d AttameY � M IC 61.1-12-0.7
Pd person (num6er and sbee4 �N. sbte. and LP co0e)
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