HomeMy WebLinkAboutMortgage_DillonC`�N�'� 5"q � �
"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
__ FOR DEDUCTION FROM ASSESSED VALUATION
sa� r� aa�w �ai� � sus)
�' ,�,. � Prescibetl by Department o1 Local Govemment Finarce . .
ile Mark
INSTRUCTIONS:
To be filed in person a by mad wiN fhe CounryAUditor w Counry Reoorde� o/ Ne counry whe2 the property is bcated.
Fi%mg Dates: 1 J Real Property. Must file dunng the year lor which the deduction is sought.
2) Mo6de /ManufaUured Homes not assessed as Real Properly Must file dunng the hvelve (12) moriths
6efore March 31 07 each year the deduclion is sought.
See reverse side Iw addifionel inshuctions and qualifications �
t rar cont�aC bN^�- � re�s o^!➢�Ti� �e), _
�Cyounry Auditor
p�nry Recorder
wng /, Key i �eya aesa�� RemN number Page numbrl
V � ,,jU-�UU- Go% %i`�-Go2�
rdh�e d mal qoperty at d Mortgage/ Contract 4de6te0�ress unpaiO az U Matgage / ConYaft in0ebted'mss �mpaid a d b Ne appG�t tlfe sde
mtli 1. qmnt year Merrh 1. n�rteirt year date of appGranm legal a eQUitaNe oxneYi
7 � ❑ Yes ❑ No
no, whal is his I her eYaU stiare o1 interest? If owned wiN someone other than spouse. ind�ta Wih nirom
rwrie m remN
contrati se0er
or oontract se0er (nvnDer erd sbae4 �Y. sbte. aid LP cade)
Name of assignee w Uhu owner or halder of mMgage
AECress of assignee (num6ar aM atree4 mY. state.
Ooes appli�anl own property in eny
munry in Ind'vna? r-� ..
amount al
20 � 20
ZIP catle)
If yes. �Mat munq/? Wtpt Ta�dn
COUNTYAUDROR
20 _ 20 _
Counry
Is pmpertyinQUestion:Mnui
Real Property ❑ MnUal
Alodle
Ih¢ detlurfion Eeen raQUrstetl m p�opnity
�.....,.,....�'_ —
Dra���cr NO....�D0�1......
— Card NO. �22 3
p.....................
_ ,ff %�j', Crc,O, W
I/ We certfy uMer the penalry ot perjury Nat ihe above aM furegoing infwmalion is W e and cortect afM Nat Ne applicant is a resident of IndWna aM
owner I contract buyer of Ne atorementioned pfoperiy on date appliration is filed.
i?Tture (aMners f� reme) _ Date (rrrnth. daY. YgsA
dry, shate. end LP mae)
g't S S (-;..
q' MAY execu�eo Fower wnvorney
Pdtlress of authar'ved 7e�^ (numDel arM sbeet �Y. sfale,