HomeMy WebLinkAboutMortgage_Michel (2)"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ = FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Fwm 43109 (R77 / 6-09)
� � Presaibetl by DepartrtreM of Laml GovemmeM Fumnce
INSTRUCTIONS: D
To be frled in rson or 6 mail wifh the Coun Auditor or Coun Recorder o/ fhe coun where the ro �� ��
a� r h N ry v aem;si���. % nQ
Filirg Dates: 1J Real Property Musf file durirg the year fo� which the deduction is sought. Coo}Sty+ quditor
2) Mo6ile / Manufactu2d Homes lrot assessed as Real Properfy Must file dunng the tweNe (12) months �� �nty Recorder
6efore March 37 0/ each year the deduction is sought s
See reverse side lw additional inst/uctions arM quali�icafions. GI8
noo�+came.orcacrtaclnuY?�-�/ay/x'.m,��/e�,ses;ee) M • � n uD�rne
T- �isficY \ num0er/I 10 ptm_ ��DD +� '/�O �� RecotdmimOEr Pagenum�/ef
� ,� � — � V
AsesseE ralue of rnal pmperty as of Mor(�ap e/ Cont2G'uWe6tedness unpaid az d Mortgage I Con7aG inEebteEness unpai0 as o( Is Ne appfcanl the sole
Mart�h 7, arrad yrar Mart3� i, Eata of appGmtm legal a equitade oxnef?
❑ Yes ❑ No
tt m. what a his / her erxt shara of intemst? If wrtred wiih sortieone other Ihan spouse. iMkate wiTh whom
tt name on 2mrtf is N9erenl than that of aPP�+4 ��� ��' Is the pfopeny in puesam: Mlwaoy A�s�sed
❑ Real PrOpEertY ❑ !?�����Y � . . .
rtnrtgagee u contracf se0er (numbrf and svaef,
Name at asvgnea w otlm,r ovmer or hdder af mongage
PAtlmsS of astignee (numberaM Stree4 �1: slete. entl ZIP mtle)
DoeS epplitant am property
munry m Ind'aia? r
Has Nis deEUman Oeen requestetl m proprity
for curtent yea(.+ ❑ Y�
❑ No
COUNTY AUOROR
Deduction appmveC in ihe amount aE -
20 20 20 20 20 20 20
Sigrewre d CounryAUEimr Counry Oate (month. day, yea�
I/ We certify under the penalry o( perjury Ihat ihe above and foregoing infortnalion is We and cortecl and ihat the appiinnt is a resident of Indiana arM
owner / contract buyer of Ne aforementioned property on date apDlicalion is filed.
fawre (o rs !W na e) � Date (month, day, yea�
� I dent adtlress of appfrcant (nu r and sheef, ciry, state, arM P ootla)
Permn authorized Dy duly exeaRetl Power of Attwney or by IC 61.7-12-0.7 Date (monN, day, yea�
AOCress of auNrn'¢ed person (number a�M sbee(. dry. state. aM LP tode) . ` ., .- ^ " ' _"'_
" /