HomeMy WebLinkAboutMortgage_Andersona^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE;
FOR DEDUCTION FROM ASSESSED VALUATION
siaie F«,� as�os �Fts i z-0»
�' ` Presrnbed by DeparimeM W Lacal Govemmenl Finance
iNSrnucnoNS:
To be hled in person or by ma8 with the CountyAuditor of the couMy where the propeAy is located.
Fding Datas: 1) Reel Property: Dunng the 72 months be/ore June 11 d fhe yeai the deduction is to be eRective. ���Q
2) Mobile Homes assessed under IC Gf.l -7: Behveen January 15 and March 2 of the year the de��is FD tlA�eff�c6ve.
See reverse side la addifbnal ins6ucfions arrd qualifications.
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I�Sne m rer,ad is diRerenl �han Ihal oi applican4 ��dipte below:
Name af mohgagee ar conlract seller
Address of moAgagee ar mntrad sdf
/- 0� a77-o� a6 3 d
aa indebteaness unpaid as or r.�arcn t. �s u,e appsrant ure sde �ega� « equi�ade o.meR
I O D - ❑Yes ❑ No
If owned wM someone dher Ihan spouse. udicate wi�h whom.
Is �he property in question:
❑ Real P`pperty ❑ Mobile Home (IC G7.1
�V ��
�erana sVeet. dty. stafe. arrd ZlPcode)
Name af assgnee or dhr� oaner or hdeer oi mMgage
Address of assignee (num6el aiM street, dty, stafe, and � �
Oces applicanl wm PopertY in airy dhs �ra wer n,� • O Q� �
couniy in Indiaral �Q � � �
❑Yes ❑ No ••• •., p
Card �'O. „ . —�
Deduction appio+ed in Ihe amwnl oE •�•••• ...
�
1 I We certifv under
� � p— � �—
the above and fcuegoing infomwUOn is We
�erty on March 1. 20 _ �
20
been requested on property
❑ Yes ❑ No
20
I Dale �N, tlay, ea�
�_l(o-Ol�
and thal the applinnts was / were a resident of
D� (ma,r�, eay. y��
�d�/n addrass ot applicarrt (number and s6eet�. and ZIP oode) p ^ / [� / (�'
..UL`— �_ �:G1`Of.� �'�.i f–(JrT/-�GO�.c� �•�/ ( �OY6
Pason authonzed by Cuy e�cecuted Pawer of Ntomey or by IC 67.1- 2-.07 Date (mmfh. day, yea�
Address of aultmr¢ed pnlsm (number aM sGeet, tlty, state, aiM LP mde)