HomeMy WebLinkAboutMortgage_Hasenour^' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
:. —
s FOR DEDUCTION FROM ASSESSED VALUATION
.. � Slata Fortn 437091R11 ! 609)
�' ,,,, � PresaibeC by DeGanmeM of Loca1 Govemment Frence �
�STRUCTIONS:
To be lled in person or 6y mail witA the CounryAuditor or Counry Recorder o/ Ihe county wheie the pmperty is located.
Fdirg Dates: 7J Real Properry: Must !le dunng fhe year /or which the deduc�ion is sought.
. 2) Mo6�le /Manufectured Homes not assessed as Real Property Must file durirg the fweNe (12) marths
6efore Marth 31 of each year the deducfion is sotght.
See reverse side far additiona/ instructnons and qualificafions.
App&yrtypwner or convaU 6py@r- see reggL'ms on reverse side) ,,
]
l lrer eraG slwe o( interest?
If rame m recorE is diflerent �han Nat o( applifan4 mdinte Eelow.
Name o( nnrtgagee ar mntraG SNIer
lddress of mat9agee w
Name
mortgage
sta.e,
Mwt9a9e I Con:rad uWebtednrss im7aiA as
date o( appfi�tian
I T;ountyAUditnr
ty Recwder
T4-AQ617�6�—
� Page numCu
Is Ne appG�anl the
kgal or epui1a61e ovrtie(?
❑ Yes ❑ No
tf wme0 wiM mmrone dher Ihan spasse. indirate with whom
ACCress oi a�gnce (numberaM s�ee4 �1; slate. sM LPmtle) .
Oces eppikant v+m yopnrty in any aNer ..`Nhel Tabrg Disiricl7
munty in Indiara? ❑ YE5 '
Drativei• i\'O. . —
i a?O�/_ —
Deductirn apprv.ed'ui tl�e amount of. �"
Card i\`O. ... �!�'b —
zo_ zo_ ......�..... —
s�qren,re w Camb abrto�
1s iM V�PQnY in Gur..Urn: MnuaM Assessetl
❑ Real PmPertY Q MnualyAssessed
Mohle Fiort�e (IC G
Has Nis tleCUUion Ecen requeste0 on Droperty
(ar wrreM Y�n � Yes ❑ I
zo I 20
I I We certify untler ihe penalry of perjury that the above arW foregoing infortnalion is true and cortecl and Nat Me applicant is a resident ot I�iana aM
owner j contract buyer ot ihe aforemeMioned property on date apPli�ation is filed. __
Outy erecuted
Pedress of aW�of"ned per:.on
���ary�re. and ZfP catle) ` '
ll A1G
>( AttaneY a M IC 61.142-0]
5tree4 �h. sfale, andLPCVtle)
Dare (monlh. day, Yea�