HomeMy WebLinkAboutMortgage_Wayman"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear �
__ : FOR DEDUCTION FROM ASSESSED VALUATION
, State Fam 43709 (R71 / 609) '
� � PrewibeO by Departmenl of LoW Govemment Fwrxe
� File Mark
INSTRUCTIONS:
To be filed in person w by mail with the CountyAuditor or Counry Recorder o! the counry where Ihe property is located. F '
FiN�g Dates: 1) Real Property: Must file durirg the }rear /or which the deduction is soughG ���
2) Mo6de / Manufedured Homes not auessed as Real Pioperty Must fiie dunrx� fhe twelve (12) months �
befae March 31 o)each year tha deduclion is swght. ❑ � �
See reverse sede /or addifional instructbns aM qualifications. G�
M0�9�ownerar contraa by�er - seeleshiytions m mverse side)
�
m.
e(�IegalEesvip' R¢wrtinump¢r Pa enu
�- 4�- U- 000. 7s� - QaG �
Mortuage/ Contract iMebtetlness unpaid az of Mongaga I Contraa mtle6tedness unpaid as of Ls Ne appli�nt Me sde
Mamh 1, artent year tlate of aPW��+ /y�,� legal w equitatle amM
�� l�l.t� ❑ Yes ❑ No
tl owned wiN someorre other than spouse, ind¢ate wiN whom
narne on 2mrtl iv 6Rnen[ than that of appOcanl. Indifate Cebvr
Name of rtart9a9ee or mntract seOC� /�
G,
Address of mortga9ce ar mntrad seller (mmber r
Name al assgnee w other awner w holder of mM�
AdC2ss o( assi9nee (num0er alW shee4 ary. s+eta,
Dces aPptimnt ovm property in any oNer
oou�LLyin Wana? ❑ Yes
❑ No
Drauction app�oved In Ne amoun[ oE
20
Sig(utlrte U Camb Auditor
20 _
ee1 �y. slete, and LP cade)
Z/Pcode)
Ityes.whatoouniy7 Whatiariig0istriri?
COUNTYAUDROR
20 _
I I We certify under Ne penalty of pe�ury that the above and toregc
owner I wntract buyer ot the aforementioned property on date appl
� ���ni�m�„s,�
FWI adtl�¢ss
x /Oa E fv
� Person autMmed �y
s+ree4 ciN, s+ate. entl LP oode)
au0�orrzetl persan (numberarW street �: sbfe, and ZIP cada)
Is ihe pmperty in QuesUm: MnuaOy Assessed
❑ Real RoPeKY � ��Y �
Has Ih's dedumon
rw a,�n y�n
� �,��Y� � �A y��,�
���� ���
en requestea an proprlty
❑ Yes ❑ No
2� _
•, day, yEa�
resident of Indiana arM
day,
c�/Y//I