HomeMy WebLinkAboutMortgage_Brewster (3)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co I Year
,. = FOR DEDUCTION FROM ASSESSED VALUATION
S�IeFwm43709(R17/6O9) OCT 3 ZQ��
•` y�. � Presaibed �y �ePaRment of Laml Govemment Firence
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wsrRUCnoNS:
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To be filed in person or 6y mail with Ihe CounryAUdifo� or Counry Recorder of the county where the piopertyl� IOCaON COU TY'@9p
Fding Dates: 1) Reaf PiopeRy: Must file durirg the }rear Por which the deducfion is soughL �� BS ��Qq�y p,�d���
2) Mo6i7e /Manufactured Homes not assessed as Real Pioperty Must file dunrg the hveNe (12) months /�y�
6efore March 37 of each year ihe deduction is snught ❑ County Remrder
See reverse siCe for adtlitional inshucGons and qualifications.
i(owreraroontradbuyer-seeresvictionsmrererse ' )
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Taam Distrirt Kev iwm0er / I 'ption RemN numEel Page numOrf
ed vdNe of 2a1 popemj a d
1. br�aY year
rq, whai is his I ha axatl share ol interest?
narrw on rema s amuen� wo mac
m
-/ -/ � �7c3 a � �!7
Mortqage / Contraa IntlebteEness unpaid az af Martgage / ContraU iMeMetlfress unpaid as d Is Ne eppOrant Me sole
Marrh 7,GqI rtent yrar Eate of apptintion legal or eQUha61e amel�
� JO OO� ❑ Yes ❑ No
If ovmed wiN someona dhar than spouse, iMicate with whom
ttie property in QuesUOn: MnuaDy PsesSed
�Real FoPerA' ❑ Armuany Assessed
Address of rnofigagee w wntracl seAer (nwnbu and svael, cdy, sfate. aM ZIP code) - ^/
/3R� n � -r
Name of ass'gnee or other ovmer ar holder of rtqrtgage � S� /�� ���• M
v /� 1
Address ot assignee (numDer and atree4 �1: slete, ard LP cotle) ,' I, �/�J �E�
% /
Ooes aPP��N rnm pfoperty in a�ry oUter If yes. what munp? // � S% /� I m C��Y
counry in Intliana? ❑ Ye5 ❑ No
❑ No s
approueC in the amourLL af.
20 � 20
COUNTYAUOROR
20 20 _ 20 _
Caunry
�_
Date (month. daY. Y��)
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I/ We ceNfy under the penaly of perjury that the a6ove and foregoing intwmalion is We and cortec[ arM ihat the applinnt is a resident ot IrWiana afM
owner I contract buyer of the a(aementioned property on date applicatlon is filed.
arewre (o�7Rr's hIDremeL n Date (monih. daY. Yse�
FulTraeiCent atltlressb{a�pGwnt (number antl sLeet dry state, arM ZIP oode)
�c 7y-Z! ,$o�;,, S�NUSt �� T.� �x�, �
Person autM�rzed �y Outy ezecuteE Paxer ol Atlort�ey or by IC G7.1-12-0.7
person (number a�M stree; ciry, sbfe. and LP code)
�y,