HomeMy WebLinkAboutMortgage_DaubenspeckX
ry� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 93709 (R11 / 609) . �
, w. � Prewibed by DePartmeM of Laml GovemmeM Fnance �
fk
INSTRUCTIONS: Ftrm
To 6e fiied in person w by mail with the CounryAuditor or Counry Recorder o/ Ne county where fhe pmpert��Jc�cal�.5 � I U fl� ��
RTirrg Dates: i) Real Property Must file durirg the year (or which the deduclion is sought. � Counry Auditor
2) Mobde / Manufadured Hanes not assessed as Real Properly: Must Re during the hvelve (72J monfhs
6ePora MarcA 37 oleach year Ihe deduction is sou�hG . ❑ County Recor�der
�ry�M �
see �everse side /or additional instructbns arid qualificatfons. �/
owxruoonlraC�r-see mrewrseside) /] n
7 y W�
/
'a�dng District Key nanhes / legal ' RemN num0er Pape nu
(p-A�q� -D - OD-001. �TSS-Oa2 O !7 7
Ma�d� 1. �rar � � Mardi 1. awrtem veer e6tetln¢ss unPeitl az o( a�9 (9�/�t� 'videbteCness unGaid as o( � aPedW�tle BamrYl
..T'srJ
��� ��
������o-��e� �/�
Address of nnrtgagee or mntrap seller (number and stree4 �Y. smte. aM Zll
Name of assignee w oiher owner w hdder of rtnrtgage
Md�ass W assi�F� (nvmbe�� street �1: �� arM LP code) �—
5 3
Dces epplifant own property in any oNer It yes, what munryR
counryinlndana? ❑ Ye5 ❑ No
D�uctirn app�vred in tlre amount oE
❑ Yes ❑ No
� spouse, IM'rate vNh rliun �
�L�ir�.�z., �LC�R m
��txx.c�.c., D
ao �o - �83�7
S• 4�r9�
NT2t Taritg OStrict7 !ia
���
Yes ❑ No
20 _ 20 _ 20 _ 20 _ 20 _ 20 _ 20 _
�nanrte W CoimryAWitw Counry Da�e (nwNh. daY.1��1
1/ We certHy er the penalry of rjury that Ne above aM foregoing infortnatim is true and cortect and Nat the applinnt is a resident of IrMiana aM
owner I contraa buyer of the aforementioned propertxo� date applic�tioaJC-fif d�.
,,.� - � Date (nrmtli, daY. Y�A
resuenc aonrrsf�6f appfxant (numner a�o s�ee�,
��
Pason authol2eO Dy EWy ezeaned Power of AtivneY ��' IC 61.
Pddress of author'rsed person (numberaM sbeef, riry, stdfe, aM 2
l,v S
r,
6w�i�sVI�LC r
°� `""'""_�y �'' 6