HomeMy WebLinkAboutMortgage_Niehaus^�� STATEMENT OF MORTGAGE OR CON� T�1 D�E�E�N�S
� FOR DEDUCTION FROM ASSESSED 1AAL�'FIAN
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.• SfateFOrtn43709(R71/6-09) NOV 29 2011
4' � Presaibetl by Department of Wnl Govemment Fnance
Coun Township Year
File Mark
�STRUCT70NS: C �
be filed in person w by maii vnth the CountyAUdROr w Counry Recorder of the counry e e property is located.
Fd"mg Dates: 1) Real Pmperty. Must file during the year /or which Ne tleduclion is sough .
2) Mo6�7e / Manu/adured Homes raf assessed as Rea�� (}GStYF�TiG61d� ��Ive (12J months
6efore March 37 of each year Ne deductron is sought.
See reverse side !or additional instrucGons arrd qualifications.
AGPfra�l (� G 1- see m reye�e side)�
1 rdue d real poperty as ot
aa�errt yrar
If ro. what is his / her ezaG share oi interest?
If name on reowtl is E'Meren� than that o( app6pM, intlira[e Gebw.
Name of rtqn9aJee «
or mnbaa seder (number arM snee{ �y, sta:e,
or oNU owner w Imlder M rtprtgage
AdCmss at ass��ee (numberariC sdee4 �: sfete. antl ZIP cnde)
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� D���,;,��� �To... �11.......
Cac-d NO. ...�.�.�
.......
�a�,�.��
I/ We certrfy uMer the
or pe "�7�
orerykntioned.�rty on
F� resident atldres of appGrant number aM streef, tlry, sbte,
� �-2.3 � G+.%, q �J S
Pason aulM(aed 7y dNY �ecvreC Power W AltomeY or Sy IC 1
Form tded wiih:
Counry Aud"rtnr
❑ Caunry Recorder
db-3oa- 0�7. oSo -c�S � dc:
inde6tedness unpaid az of Mw�qage / ContraG irWeMedness unpxid as W
r �^� Eate of applifalim
person (numberaiW sbeet ciy. state, aM ZIP cade)
�r owced wim somerne ou�er wo spouse.
wnat rap�q oav�a?
COUNTYAUDROR
za zo _
` P�e T / W
Is Ne appfirant ihe sde
legal w epuitade oxneR
n Yes ❑ No
IS Ne MdDeRY in QueStion: MnuaDy Asse�d
❑ Real ProPertY ❑ Armually Assessed
Mobile Fiome fIC 6
Has Na deduc�ion Eeen reQUestM m pmprity
m� «��,u y�r n .,_ _ n
� I �
�Y Y��)
infortnation is true and cortect arM Nat Me applipnt is a resident of IMiana a�
ion is filed.
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o� t„�m, ear: rean