HomeMy WebLinkAboutMortgage_Walker (9)^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ip r
__ � FOR DEDUCTION FROM ASSESSED VALUATION
�• sraca Form a97oB (R71 � s-os)
� � Presoibed by DepartmeM o( Lnd Gm�emment Frence
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�srnucnoNS: Ar�<
F«�„ mea wrtn:
To be filed in person a by mail with Ne CounryAuditw or Counry Recorder of the county where the property is located.
Filing Dates: 1) Real Pioperty: Musf (de during fhe year for which the deduction is soughL � �' MCou tor
2J MobAe / Manufactured Homes rrot essessed as Real Property: Must file during the hveNe (12J monfhs ❑� �
6e(o�e Mamh 31 o/each year the deduction is sayht GI SON CO NTY �
See reverse side /or additional instnictions and qual�l'icafions. �
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IV�1, % � �
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m recwE a 6Rem�t Man that af app6cant, mE'uata Eebw:
mi
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xa 4debtetlnm unpaiO as ot
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Plamemrrongayee«mnaaasener /"� /) �., � /
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pAtlress ot nqft9agce or cantrad seller (numle�aM sllee�'crty slate. a{
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Name of zssignee a oNer awner w haldu d matgage
AdCress of assignee (numbererd saeet mY. stafe. ard ZIP cotle�
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DaeS applirant a,�m property in any aMrl If yes. wha! m�^
cou�LLy m IMana? ❑ Yes �'
❑-u"—_
-0�
If awned wiN sonieorie othu
,c�u 3 3
Whal Ta�drg Distri!
� Is the ePP��t Me sde
legal or equitaGe awne(.�
❑ Yes ❑ No
vitwm
�� P�Pert1' in Oue50on: Mnu90y P55es5eE
Real Property ❑ Arvndly Assessed
�
m propPrty
❑ No
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�� a�l,�.�,.•• OUNTYAUDROR
Ordumc � O . . . . .
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Sig�uture c Caunry Date i�. daY Y��
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I I We a _..� ver7ury that Ne above and foregoing informalion is W e and cortect aM that the applinnt is a resident of IMiana a�
owner I i,,..,�ea buyer of the aforementioned property on date appliwtion is filed.
SigreLUe (awrars l�+�eme) n, Date (mWh. deY. YmeA
address d appGpnl (numbe� and sbce4 �Y. �+e.
Person aut7roraed by
persw� (numDa` arW shee4 �Y. sfate, antl ZIP code)
Date (monN. daY.