HomeMy WebLinkAboutMortgage_Skaggs^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township �ear
___ � FOR DEDUCTION FROM ASSESSED VALUATION
• Sta[e �ortn 43709 (R11 / G09)
� � Presvibetl M �ePan�M of Loca1 Govemrtrent Finaxe
� File Mark
�IS7RUCTIONS:
o be fiied in person w by mail wiN the CountyAUditor or Counry Recorder of the aounry where Ihe pmperty is located. F
Fitirg Dates: 7) Real Property Must !de dunng the year for which the deductlon is sought. �, ���
2) Mo6de / Manulactured Homes irot assessed as Real Pmperty: Must file dunng the twelve (72J months
before Ma�ch 31 of each year the deduclion is sought. ❑ � �
See 2verse side lor additiona/ instrucLOns arM qualdicahons. G I
AppGCan rorconvac+buyer-ye� qJrererseside)
paprJ,y az d
no, what's Ns / her e� share of interesR
'�� o.s- oo i. - oaG .__.� .._ . _s_.. .�.0
no-aa inaeeteanesx u�paid as or Mortgage � conva�l mtlentetlness unvab � d Is u�a eaa�n me sok
nt year date o/ aDP�� % /� � a eWilade owrw(.+
/pj / �� ❑ Yes ❑ No
It rame m rncad'a ddterent Wn ihat d appGrant'v�Eitate Debw.
Name of mwt9a9ce or rontraU
nearess a mat9as� or mno-ad
w oCier owner rn holder oi mortgage
Address of assignee (number eM street, dry, slate, aM ZIP
riry, stefi, anC LP mde)
�f owned wiN someorre dher than sWUSe. irM�rcate whh whom
u
Is iM prapeny in Cuestim: Mnua�Y Assessetl
Real PropeAy ❑ Arvwally �
hb60e Flane QC G7.7-71
-
- S JA,� ES � D
SK� �
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Oces app&anl awn WopeM1y in any oNer If yes, what munt7� What Tari�g Dis6
munb in IMiana? ❑ Yes � - �
❑ No �J No
COUNTYAUDROR
D¢EUCtirn app�oved m tl�e artaum ot
20 _ 20 _ 20 _ 20 20 _ 20 20 _
SignaMe ot Counb Audiior Camb Date (manh. AaJ: Yea�
I/ We certify under the penalry of perjury Mat Ne above arid foregoing infomialion is true and correU and that the applicant is a resident of IrMiana aM
owner I mntracl buyer of the afo2menlioned property on date applualion is filed. �
nue (owrrelS fiilname) / _ Date (rtarvh, daY• Y��
Fdfl revtlent atldress d appGcant (wm6e[iAtl�freet. aty, sfate, ard ZIP ootle)
'7g'�3 9 S_ ��lP L.J (=a,�� �iL.
erson authonzeE by Euty executetl Power of Attm�ey by IC G7.1-12-0.7
PdCress d aWnr'aed persai (num6er aM strete; tiry, state. an0 ZIP code)
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