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"^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T ear
FOR DEDUCTION FROM ASSESSED VALUATION
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File Mark
WSTRUCT70NS: `—yy� �
To be filed in person w 6y mad with the CountyAuditorW fhe courrty where Me propeify is bcated. !�'��
Fding Dates: i) Real RopeRy: During the 12 months be/ore June 17 0( the year fhe deduction is [o be alfective. Y AUDITOR
2) Mobile Harres assessed urMer IC 67.7-7: BeAwen January 15 and MarcA 2 of fhe year fAe deductid'Ai�� ��i �
See 2verse side /ar additional insWctions arnd qualficafions.
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Key munber / legal dw'oiption
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or tAarcfi t. arrern ymr MMgage � com
a�rter0. year ,
is hs / hm exacl share oF
mrecard
nqrlpagee or caqract seller / �` n— ' �
lN k���� (j Q
of rtpM1gagee or oonUad seller (number arrd �xe4 dty, stdfe.
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Reoord rwmber
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If wvned wdh sorneone ather Uan spouu.
Page num6er
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❑Yes ❑No
Is Ihe yoperty in question:
❑ Real PivpeAy ❑ MoWle Hm�e
Name of assignee a ather o.vner w hdder W rt�Mga9e
Address of assignae (nmber a�M s6ee4 �'. 9efe. and LP oode) � . \ o\ �-C1L��y��'I�
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