HomeMy WebLinkAboutMortgage_George""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
__ : FOR DEDUCTION FROM ASSESSED VALUATION
:• State Fwm 43709 (R71 / 6-09)
�' � PresaibeE Cy Departnrent ol Lnoi Govemment France
��° File Mark
INSTRUCTIONS: Fo ��
To be filed in person w by mail with fhe CounryAUditor or Counry Reco'der o/ the county whem the pioperty is locat .
FiNrg Dates: 1/ Real Pmperty: Musf file during the year 1or whicA Ne deduction is soughf. e�ty � r
2) Mo6de /ManuFactured Homes rat assessed as Real Pioperty Mus! file dunng the fwefve (72J months
6efore lAarch 37 0/ each year Ne deduction is saight. N V� sCoun Remrder
See reversa side lol addiUOna/ inst/ucflons and quali�cations. .. _..
Appfican or vyer- sre m re side) � ��
rad�go�aa�a• icev�ceri�eg�,a�c� _[;� . W ir� ��A,SWM].°"�,
s�sM vdue o( r� papelly az W
mCi 1, aarent year
M� Wttal {5 �16 i�lff CXdflS�ldf9 Oi Vl}CfCSl%
-/5'-/0 - /�� -00�
� MoRga9e / Contract iMehtedness unpaid
If n2mC Otf RNfd 6 EiIfPlCllt Ndn lhdt of appOCan;
w mntraU se0er
Name of assignee w othu
AdCress of assignee (number aM stree4 �Y. ��e, and
Does appliont own property in any oNer
munryinlnEana? � ..
of
zo I zo
i
ctly. ga�, aM LP code)
-3{/0
I( yrs. what munt�?
GOU
zo zo
someorre other �han spouse,
�
�
a d Is Ihe epplirant Me sole
legal w epuita6le amM
❑ Yes ❑ No
wM wtrom
Is the property in 0���^: �nuaP/ Assused
❑ Real Ptoperty ❑ ArmualyAssessed
4Mat Taring D"sttirll
DI'111'�l' �`Q..Af/�q -
W..j�........
5
1UDROR
Card NO. ....3��J
. .
-� '� � �?,CCO, � ..
(r�m. dar rea.�
I/ We certify under Ne penalry of perjury Nat Ihe ahove aM foregoing infomiation is true and cortect arM Nat the applirant is a resident of IMiana arW
owner! conpct buyer of Ne aforemerrtioned pro0erty on date application is filed. "' "" "� -` '
street, dry slate, and ZIP
Person autlqirzed Gy duty ezewted Power af AlfwneY a�' IC 61.1-12�.�
Pdtl�s ot auCmr¢ed persan (number aM sbee; ciry. s1a(e, aM ZIP mde)
Date (rtpnlh. d2Y. Y��
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