HomeMy WebLinkAboutMortgage_Bresnahans� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
staia F«m as�ae �a r 2-0��
�6 aw '� P�esrnted by DePaNment af Laal Govemment Finance
�NSrnucnoNS:
To be filed in person w by mad with the CourrtyAuditor ol tfie courHy wheie the property is bcated.
Fd'a�g Dates: 1J Real Property: Dunng the 12 months be(ore Jurre 11 of the year the deduction is to be eBactive.
2) Mobile Homes assessed wdei IC 61.1-7: Behveen January 15 and March 2 of Me year the deduction is tw�fi�cti�.200$
See reverse side fa addtional ins6vctions ard quaGfications.
qpp� ( iar buyer-see mreve �de) �p.�
� U
Tauig . - eynum6er/Iegaldesaiplion P85
I If nu, �
rum6er
o. o0 0_ o�� aoo � 33
value propaty rdi 7, aarent y�r nw�� i co�vaa �,d�d�� �,�a � a��n i, is ma �r�t u,a sde i�i «�uae o«�r
�R��� � /1 � Ll Z l ❑Yes � No
Name of mortgagee or cmUacl sNler � /) �
C/� .
nmless ot nar�qagee or m,iraa seller (numaer and s6eet ary. srate. and z�v code)
Name of assgnee a dher wrt�er w holtler of matgaga
Addn� 1—"—" "___""_"'_".'__""___�.-.,..�._� _ .
a
�°� , Di-a�vec• \�o. a.6 - 3 3
coun '
: .............
�'; Card NO.
.....................
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wiU� someone olher Ihan spouse,
Tadng Disiricl7
20 _
Ihe propeM1y
Real Prop
❑ Mobile Home (IC 61.1-7)
Hes Uus tled�xtion been requested on pmperty
tor wrrenl ye2(1
❑ Yes ❑ No
zo_ 20
oa+e ��w. ear. year�
I/ We certify under Ihe penalty of perjury fhat Me above and faegoing information is true and correc[ and that the applicanfs was I were a residenl of
Indiana and owner of fhe atoremen6oned property on March 1, 20
v�ali nn lnu�nn/.a fiel rumel Daie (manfi. daY. Y��
�j F - i¢� address of applicant (number and
/` %�1S Ov
Persar� aut}wrized by duy exewted Power of /
Address of aNhoraed person (number artd sG
d(y, slate. aiM ZIP cade)
rdy, sfate. aIM ZIP mde)
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