HomeMy WebLinkAboutMortgage_Catt^' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
= FOR DEDUCTION FROM ASSESSED VALUATION
�� � � . .. Sfate Fortn 43709 (R11 ! 609)
� N,� P Presvibetl by Department of Local Govemmenl Finance
File Mark
�srRUCnoNS: �PR
Fo wBh:
To 6e filed in person or by mail with fhe CounlyAuditor or County Recorder o( the wunty where Ihe property is locat .
Frlirg Dates: 7) Real Property: Must file dunng the year /or which the deduclion is soughL Counry Audimr
2J Mobde / Manulactured Homes rrot assessed as Real Property: Must file dunng the (weNe (72) montfi3.�. M y
6etore March 31 of eacA year the deduction a saght. � �'Gounry Recorder
V
See�versesideloradditionali sln�c7iw�sarMqualifications. N COUNTY AUD
�n' n / /. � / / /1 / ( i1% �/ / �e'
If no.
Key
s�ro������r�
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than ihat o/ aCP�^L'mCipce Gebvr
Nartre o( mortc�agee a mntract seoer
neer¢ss ot rtprtgagce or �ono-aa sPner
Name af assignee or otha wmer w hd
AdEress of ass9� (numGer ad snee
r�,a
pry, state. anC Z/P code)
� aPWicant o.m WuP�Y in any oNer If yes. what wunq/1
counrymlMiana? � Yes ❑ No
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Dra�ver \'0...........�......
5 Card \O. ..... �.�:�.......
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vwne� � un��a....,.�... ... _._ _._. _..._______ _ �_ _•....,
- DO . - Oo�1 OrU / � � �v
npaid as of Mortgage / Contratl uMebtetlr�s unPaid as of Is Ne eP�� Me sde
Eate of app�Cation kgal n equitaGe amM
3 p� �� ❑ Yes ❑ No
If avmed vriN someane dher �han spause, IMicate wBh whom
Is properry in auesson: nnrc'aoy tv�sesue
Real FhoPeKY � �^^�N�
Moh7e Hort�e fIC 61.1-i
.,�-�� /93.
du�Yirn Eeen re0uested m proprny
�r ❑ Yes ❑ No
zo 20 _ zo zo _
ca„�h oa�e ���vn. ea,: r�o
aegoing infortnali0n is W e and correU arM Nat the applinnt is a resident of Indiana ard
,� appliption is filed.
Date (nonfi. daY• Yaa�)
FWI r�sid�t�ddr�%dl�p�ta�t (numbe� an0 stree4 tlry, slate, ane zfP ooi
l�3 � 3sz�va P'u�
Pason auNOraed Cy EWy execvted Power of Anomey a Cy IC 61.1-12-0.7
AOEte55 ot author'vEd persM (number am/ shee4 �Y. sYd(e, aM LPCOtle)