HomeMy WebLinkAboutMortgage_McClanahan^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBT�E�S Township Year
r__ ; FOR DEDUCTION FROM ASSESSED VALUATION �
Sta[e Fortn C37091Ri1 /6-09)
�' Presaibed by Departmern of Local Govemrtrent Fuiance JAN
� File Mark
�ISTRUCT70NS: C �
Form �i ed wflh:
io 6e �/ed in person or 6y mai! with the CountyAUditor or Counry Recorder o/ the counry where the property is lo a� —
Filirg Dates: 1J Real Pmperty: Musf file dunm� the year /or which the dedudion is sought � Counry Audimr
2) Mo6ile /Manu/adu2d Horrms not assessed as Real Prtiperty: Musf file dunr���(g{tJ�@012fYTiNn1A41 D�7 R
' 6efore Maah 37 ot each }rear the deduction is sought ❑ Counry Recorder
See reverse side for addifional inshuUbns and qualificatbns. _
T v Di ' Key munDer I
Ahsrssed va4re d rral V�oG�Y as of M
Merch t. arrenl year M
If ro, whal k his / her erafl share of interrsi?
1f rwne m 2owd is difterent than that af appticant, u
Name of rtqrtgagee or mntt�Y;eDer q
°�'
i9-�o/aloboy-�
tgage / Contraa irdehtetlness unpaid as W
Address U mwiFagce m m�traU seller (n�mher and stree4 �; sta•'e, aM 21P code)
reme rn assgnee or omer owner ar naaer o� nnngage
Does ePdi�M wm WuFertY in any oUer
munry in Ind"ena?
❑ Yes
DetlucOOn approveC u� ihe amount of.
20
Signature d CamN nWEOr
Sldte. antl [IP cotle)
If yes, what munry?
No ,
20 _ � 20
If owried with someone other ihan spouse.
!s Cie
Reco�d num6er
unpaid 25 of Is Me eppfcant du sole
legal rn equibde owneR
❑ Yes ❑ No
Wuzte v.ith whorn
, . ,_ E
- U�� �N� �ap�
�ec`Aa�NA � �
a
What Tadr,
COUNTYAUOROR �
20 20
Counry
�
I I' �°
.� aetludwn Oeen repuested m property
' .,w wrrent Year+ ❑ Yes
❑ No
20 I 20
I/ We certify under Ne penatty of perjury Ihat the above and fwegoing infortnatim is We and correct and Ihat ihe applinnt is a resident of InEiana arW
owner I contract buyer of the aforementioned property on date appiication is filed.
yature (owners MI nart�ej� �ate (monfh, day, yean
� � ��
Full re5i0ent address
Person author¢etl
an0 street dty, slate, and ZIP
or
persw� (number aIN sbeeL �y. sbfe, and ZIP mEe)
Date (month. daY. Yaa�