HomeMy WebLinkAboutMortgage_Terron"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ .� FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 93709 (Rii /6-09)
, / PresaiGed M�G��rtl o( lnol GovemnreN Frence
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INSTRUCTIONS:
To be lled in person or by mail wifh the CountyAUditor or Counry Recorder o7 Ne county wliere the properry is located.
Fi7'ug Dates: 1) Real Property: Musf fde durirg fhe year for which the deduction is sough[.
2J A.fob�7e / Manulactured Homes not assessed es Real Property Must file dunng the hvelve (12J months
be(ore March 31 0( each year the deducfbn is sought.
See reverse siCe /or additiunal instnictlons eM qualilcafions.
(owrer oroo�r�qpuYe!- �1 msfirtons an re.erse siie)
�YIA�lW�1/1 C�
P�P�Y �
H rame m 2mN is dtlfarnt Nan Ihat W aDO�. tr�C'xate Gebw.
Nama ot mortgagea u mntrau se9er
Mdress o( mortga9ee u mntrad
Recorder
Is Me eppGmnt Me sde
kgal w epuitable wme(1
❑ Yes ❑ No
someone o0ier Cun wW�. 4Wicafe with wFam
Name of atignee w othel awnet or twWer ot rtq�gage " ' '_
Atldressofassignea(numEerandsbeet�Y•stete /•�%���• 6� '
Dra�ti�er NO. ���.�........
ooes eppinm wn, v�v�r �^ any aner
wuny in lnd'¢na? ❑ N[
❑ Yes
Card NO. . �.a:3.g......... _
Deduaan approvaC in C�e amount ot ��� _
20_ 20_ 20_�-2U_ I p_
SignaUve N Co�mb Audhor
IS CIC P�D�Y 1!1 VIICSLWI: Mf W8�'/ ASSCSK'd
❑ iteal RopenY ❑ M^uaM A�ssed
duttion Oeen reQUested m poputy
� ❑ Yes ❑ No
�
Date (monfh. EaY.
Fi�7
�
I I We certify under the penalty of perjury that Ne above and foregoing infortnation is We and conect arM that ihe applinnt is a resident of Indiaria antl
ovmer / contraG buyer of Ne afore entioned prope date applica0on is filed.
3 (owneh hArame) Date (rtmM. daY• Y�A
t pta�t Der sheet �'+1Y, , and Z e) .
' ( (Lr�sZ 6 �l
auJra¢etl Dy dWy esetwed Pa�v olAtSUneY a a/ IC 67.1-12-0.7 -,- Daie (manN. Y. .�
ACdress of aWamed D� (nam6eraM svueL M: slete.