HomeMy WebLinkAboutMortgage_Sisk"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_. FOR DEDUCTION FROM ASSESSED VALUATION
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�` Presai0e0 M�rd of lxal Gwemmem Flrerce
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INS7RUCTlONS:
To be fiied in person or by mail with the CounryAuditor or Counry RecoNer o! the county where the property is bcated. y`
Fifirg Dates: 1) Real Pmperty: Mus7 file durirg the year7or which the deduction is sought � Counry Auditnr
2) Mo6ile / Manufactured Homes rwt assessed es Real Pioperty Must file during the nvefve (1Y) monNs
befora March 37 of each }rear the deduction is sought � S��� �CO�� �
See reverse side !a additbna/ inshuctlons and qualifications.
MD���fowne� r-aearcsaiclions verse " `�%7 �
q �rd
�p;� �y — a�—� � `V�� Re�d��50N F.ddN�ASCkUDiT R
AsaseO rWue d real pnPMY az M Mort9age I Contract 4Ne6tedness unpaid as d Mortgaqe I Cantracl'uWehtedn�s unGa as of Is Me aC�� the sde
Meid� 1, aimlrt ym March 1, t date af aPp�tion legal a eWka6le ow�e�
❑ Yes ❑ No
H ro, what Is his / trer uart sha�e of intelest7 ' N awned wdh someone othm ihan sP�. mdipte wNh Mrom
If �ume m remld 6 Siilerenf Nan Na� Of eGP��L hMkate bClw/. 15 tM P�OP�Y in Guesaorr.�MrwaYy AssesseC
❑ Real ProPertY � M�obil�e YFbrt�e�IC�61.1-�1
Name of mortgagea a contract seHer
Add�ess d morigagce or oontraG sWer (mmrbar eM sbeeL �el: sbm. ard LP code) .
Name d asignee a othu owner ar halOer d moripage � �(�] F�,�/
_ t'a\\'`'Y ~� �p�i�`� �1 " � '••, .
AECmss ot atsgnee (number aM shee; ci�" ^ p .
�1`� ••..•••"•
munryam�IM�'naru? �� in anY other l.7 � �•'� � ���`deCUaim Deen rcQUesteO an pfope+ly
❑ Yes ❑ � `� U ❑ Yes ❑ No
Deduction appmvad in Ihe amount at ��� I�� .
Zp_ p_ 20_ 20_ 20— 20— �—
Sigrahue U WimryAUCitw County Date (rtpnth, daY. l��
I I I We certify under ihe penalry of perjury that the above arW foregoing intortnalion is W e and cortect a� Mat the applipnt is a resideM of IrWiana aM
er / mntra yer of Ihe aforeme�oned Property on date aPPlicabon is filed.
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Data (rm�di. daY. Y��
F restl t U appGrant (num6e rM sLee4 �: � e. eM LP code) _
Person auNOi'v.eE by duty esecuted Power ol Ai[omeY rn Dy IC G7.1-12-0.7 �(�N. �Y. Y��
Pddress af aWfo�'vetl pnJSOn (number aM stree4 �: �re, an0 ZIP mda) .