HomeMy WebLinkAboutMortgage_Sprinkle"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_ � FOR DEDUCTION FROM ASSESSED VALUATION
• State Fartn 93709 (R71 / 6-09)
S r PresaibeG by Department of Local Govemrnent Fnama
�STRUCTIONS: F ��
To be filed in person w by mail with the CounryAuditw or Counry Recorder ol the county where the poperty is bcated.
Fi/ng Dafes: 7) Real Property Must �Je durirg the year for which the deduclion is soughL N � Co'nty Auditnr
2) Mo6ile / Manufactured Homes rrot assessed as Real Property: Must file during the lwelve (12) rtwnths
6e(ore Maah 37 ot each year the deducfion is snught �� � n� '�•�8ounry Recorder
See reverse side (or additional instluUbns aM qualfica[ions.
t(owner or contract 6uyer- see msvic8wu m r�erse sitla) � . n _ • • •
ym
:�
Name ot mortgagee or contraU seller
Pddress of mat9a9� w mntrad se0
Does applrcaM o+m property in any oNer
munb in Inderu? ❑ Yes
����i9
1
appbcanl, uMibte Eelow.
�.30 -U00. � 90- od� � n� r�e�1 (p 5
S 4idebtednes5 unpaitl as o( Mwtgage / ContracY indebfedness unpaitl as W Is ihe epd�^t the sole
er date of appGU�im legal w equRahle owneR
, S O � ❑ Yes ❑ No
If axned wiM wmeore other �han spouse. udimte with wMm
5 mquestim:MnuaOyAssessed
eal RoPertY ❑ ArmuallyAssessed . . _.
�re.
er ot morigage
rdy, slate, and Z/P code)
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C81'Cl NO. .. �� ��........
.'�Z�III� �1711I �L i�7:7
20_ � p- � � � p
�naWre ot CmmN Auditor Couny Da�e (rrovh. CeY. Yee�
C' . T. 7v�a�a-�"-�>
I/ We certify under the penalry o rjury that th e and foregoing mfortnaGOn is We and corrert and ihat ihe appli�ant is a resident of Irdiana antl
owner I mntract buyer of the aforementioned p perty on date appivabon is filed.
maNre (owners N� neme) �r n n!_ Date (morVh. daY• Yae�)
itlent address d appfinnt (n�pRberaM sbee4 aty. sbtE
'0 �. l-ocusr ST. F
aW�o�¢ed Oy Mdy exerLteE Pov.er dArtaney a by IC
: of authoraed persm (number aiM strae; ciry, slate. a
ZlPOOde)
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76
oa� ��n,. aar, r�n