HomeMy WebLinkAboutMortgage_Farrar (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
� FOR DEDUCTION FROM ASSESSED VALUATION
.�,_.. ° Sbte Fwm 93709 (R71 / 6-09) � 1 � �
��•„ PresaibeE by DePartmefn of Laal Govemment Fu�ance
File Mark
wsrRUCnoNS:
.p �1 Fwm Ned with:
To be filed in person w 6y mail wifh the CountyAUditor or Counry Recorder o/ the oo�l�re [h��p�rty is located.
Filing Dates: 1J Real Property: Musl file during the year for whirh fhe deduclion is soughL � County Audimr
2) Mobile / Manulactured Homes not assessed as Real Pmperty MusLble,dqryw��ety+,�Ne (12) months
6efole March 310/ each year the deducfion is sought �' �' � (v �\ ❑ County Reconier
See reverse side fpr edtlitional instmctions and qual�cafions_ .__, ,,,r„ „� iniTOR
Ta�urg
xre�v�vagm
Y�
/ her erarl share af intemst?
m rem�E "s dMerest lhan Na� o(
'arrre of mort9a9ee «mntrarl se0er �
Addass of mortgag� v ou�tract seYn (nursiber eM sbeel �R}::
Name oi assignea or aU�a ow+xr w hdder of m+�---
� �
LUW t�� y J uN�� A-il-
��
�a -� �q 8
�_ i �
� / Cf ' ��' W _C�-/� . �3/�J Record numb� � Pa9e !uim
y �;
3ct'udebted�ss unpaid as of Mangage I ContrarS in0ebtetlness unpaid as d b tM eCG�t Ne sde
^ Oate of aGP�� Ie9al a eWitade ameY?
�j ��j ❑ Yes ❑ No
If owrred wiN sartieone ather ihan spouse, iMirate wflh whom
what count�/1
� _ , Zo
Wtat Tating Datrict7
�
Is Cre PmPenY in Vuestion: MnuaPJ Asses5e0
❑ Rea� arovenr Q nrnu,a�y wssessea
Modle Hortie (IC G7.
dedud'nn Eeen re9uested on property
ntYean ❑ Yes ❑
� za_
Date (rmnth. daY. Y��i
I/ We ceNfy under the penalry of perjury Nat the above and foregoing informalirn is W e and cortect and Na[ the appli�ant is a resident of I��ana aM
owner I ntracl buyes of Ne afaementioned property on date appli�atlon is filed.
,.,e.,� .t na „a,�n� if . Date (rtmfi. dzY. Y��
/ J u�c-�i _ vv� .- —
F esid c aAtlress ol appGwnt (number and sLect dty, stal , aM ZfP ca
�3'%O ! � 90 O S z�l�wLw,
Person authorized by Cury exewted Power of Attomey or by IC 61.1-12-0]
<ddress of author¢ed person (num6er arM s�eet, dry, state, and ZIP code)
�76
��