HomeMy WebLinkAboutMortgage_Mason (2)"�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_, + FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 437091R11 / 6-09)
, 2 P�esaibed by DepartmeM of Laal GovemmeM Fu�ance
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INSTRUCTIONS: F�B�
To be filed in per5on or 6y mail with Ihe Counry Audifor or Counry RecoNer o/ the wunry where the property is located. J�11 tl�'f
F7ing Dates: 1) Real Pmperty: Must file during the year for which fha deduction is soughL Coun`t�.�a�.
2) Mo6Ae / Manufactured Homes not assessed as Real Property: Must fiie during the tweHe (12) months C. Reeorde� ,
6efore March 37 0/ each year the deducfion is sought.
See reverse side lor adtlitiunel instrucGOns arM qualificafions. G�BSON
�or_ 6vyer-seejqmirbonsmreverseside) DITOR
� v Q'O (/k�
Ta�d i K Eer/IegalEesaip' � RemQm Pa9e �
�tC�ee� -/ ia - o - cr� �aa - o �
Aaessed waWe d real 7�W�Y az of Mp�qyge / Contraa iMebtetl�ress unpaid as U Mort9a9e / ContrarY' ebted�mss imPaid as of Is Ihe sPPGra^t Ne sole
Mard� 7. arrent Year Marr3� 1, curtent Y� date of aVPGtation legal w eW itade owndl
❑ Yes ❑ No
If ro, what a his / tcer eiad shara of intemst? If oxmed wiN someone otller Ihan . i�iqte with wlwm
If rertre m recnN is tliRerent Nan Ihai o1 aPV��4 ^��� ��' i properry in 9����: �nua0y Assessed
Real Property ❑ MnuallyAssessed
Mab�leHOme IC61.1-7)
�ame W mortga9ee or mnttaG seller ..
qEdress ot mart9agce or oa�tran seller ( number and 4 crty. sta e. aM ZIP code)
Name o( assignee w othr! ow�er or twlder W rtortgage ( �
Q
AAtlress of assg�ree (number aM 51reeG ary, stete, aM ZIP code)
Dces applimrt own praperty in any olher If yes. what counry/1 What Ta�drg D'slric[? Has Nis dedu`]ion Eeen requesteE m proprlty
munty in IriC'ana? ❑ Ye5 ❑ No For ament yeaR � Y� ❑ No
COUNTYAUDROR
oeauctia� sca�'� m ure amwm or.
20 _ n7 _ 20 _ 20 20 20 _ 20 _
Sig�anae d Co�mlY nWitor Date (rtbnfh. 0aY• Y��
(Yl�ISO �.J� �iJ1���'" t
I/ We certify urWer the penalty oi perjury I 3nd that Me applinnt is a resident of I�iana aM
owner I mnVau buyer of Ne aforementior /� �^��
�9f�� ( � ^�) . O M'� �( Date (nwth, daY.Y��)
� _ y ,
FWI resident adtlrass o1 appfxant (number an0 sbe
� Pason aWwi'sed by Etdy ezetuted PwRt of ManeY u uY i� o- t. �-��W.� Date (monlh. dfi', lea�
�Atldress of ainhoraed persm (number a� sbeet ciry. sfale. an0 ZlPcode) .
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