HomeMy WebLinkAboutMortgage_Potts (2)"'n STATEMENT OF M�RTGAGE OR C�NTRACT INDEBTEDNESS Coun 7ownship vear
�, ,. = FOR DEDUCTION FRtM ASSESSED VALUATION
Stata Fam 43709 (R71 / 6O9) ''
S ! Presoibed by �eD�rerd of Loml Gm�emment Firence
F
INSTRUCTIONS:
b 6e lled in person w by mail with [he CountyAuditor or Counry Recorder of the county whe2 the pioperry is kwfed.
FiNrg Dates: i) Real Pmperty: Must file during the year for which the deduction is wught.
2) Mo6de / Manulactured Homes irot assessed as Real Property Must fi/e dunng the tweHe (12) monfhs
beforc March 37 0l each yea� Ne deduction is mught.
See reverse side fa zddiliona/ instructions and quali�rations.
AU
Recorder
TaargDisfiG ' / 7 eY`wm�er _Ue�pt=m r1o', Vv' �� � keco rwpQer ragen
v � u .! Y l0
psesst,W value oF eeal poperty as M Mo e/ Cantraa'uWe6tedness unpai0 az o( Mongage / ContrafY ifWe6tedness unpaid as W Is Ne epplrcant Ne sole
g i
Marr3i 1. nnsit year Ma 7. rtent yeer date of aPP��� kgal w equitaNe amen
� ❑ Yes ❑ No
If no, what Is his I her eu� share of intemst? If owned vnN someone oNer ihan spouse, iMkate wBh whom
tl name m rem�d is diRerent Nan that of aDP��t ��� �b'�' Is tM pmperty in 0���: �nuaoy Assessed
❑ Real Property ❑ Mnually Pssessed
Mobile Hartie (IC 61.1-i
w contracl uller (numbai ard stree; cdy, s�m. aM LP oode)
w othel awner w hdder d mc
Mdressofassignee(numbeiantlshee4�l:s+e Di�a���er NO......��..�J......
Does ePpliqnt oum property in any aNer � (('��
counryinlndiana? ❑ Yes ❑ � Cat1�(1 �i0. ........ �N........
� I ��,aoy-o�
apyoved In ihe amount of.
20 _ � 20 _ � 20 _ � 20 _ � 20
Has Nis dedu�lim Eeen requested m p'opnity
for artent Y��! � Yes ❑ P
2p 20
Date (/��, daY Y��l
I/ We cerGfy ulWer the penalty o( perjury ihat Ne ahove and foregoing infwmation is true and cortect and Nat Ne applicant is a resideni of Indiana arM
amer I wn4ad buyer of Ne aforementioned property on date apPlication is filed.
,.......n r....,.,e.4 R�n „�,.b� _ . . . /'l . . Data trtonUi. tlav. taail
�
Person auNO�.d Oy duly
person �number arM sbce; ciry. sfate, antl ZIP cUde)
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Oate (rtronN, Oay, ys: