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"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ .= FOR DEDUCTION FROM ASSESSED VALUATION
� �a�,�,��R,,,�> FIL,E
S �� Presm0e0 by DepartmeM of Local CwemmeM Firerce
� File Mark
INSTRUCTIONS:
b be filed in person a by mail with Ne CountyAUditor or Counry Recorder of thetqyqty�¢ ele tf�g, roperty is located. F� fl� ��:
Fdirg Dates: 7) Real PropeRy: Musf file durirg the year for which the deduclion i��ghd [(J�� ��,p(nry Auditnr
2) Mobde / Manufactured Homes rrot assessed as Real Pmperty Must h7e danng the twelve (12J monfhs
a �
� . �°�D�?-�.-0 —aro
W Abr[aaoe /foxhaa'uWebtedness unoaid as of
'1aM 1, amm}year V I March 1,�rr�t
��
11 m, what is ha I her era�x share of interest?
11 name M Rtord'6 E�iRe�Grt than Nat o( aOP���• ��te Delow:
name ot rtartgagee or oontrau seva /^ ^/� ( 1/7
� � / I �/ r ��/
Mdress ot rtw4jagee ar cantrad sWU (rwmber end sbee4 �: ��, arM ZIP code)
Name of assignee or W�c owner a halder of rtqrtgage
Drawcr NO... �.
Card ivo. .....a..9.��.......
� I �,9c�4 • o�
I/ We certify uMer Ne penalty of�e�ury that
ovmer / contract buyer of the a(orementioned
le)
vhal
ve and fc
y on date
F1ID rctiCent aCdrrs d appficant (numb�ernantl sheet, dry, state; and LP m
��Oi-lq ' 4J 1 J� S �VJT-N�S�/ l
Person auNOmed Dy duly esecuteC Power d Actan y m by IC 61.1-12-0.7
Pddress of autharzEd persori (numbera� sbee( ctty. stdte, aM ZIP code)
:• �.
eate o( appGCation I legal w eWitade oxre/?
❑ Yes ❑ No
wiN somearre dher than spouse. iMUate wiM whom
ts tl�e MoPertY m Vurstion: Mnua➢Y Ass¢sed
❑ Rea� Roae�tr ❑ tw,uany 0.ssessed
Has Iha detlufYim Eeen requested on propGty
fw cu(2nt vra(.� .—, ,—,
�.�•ni:►.i_nr��►ca:�
24 _ 20 2� _ 20
Caunry Date (month. daY Wa�
�, nfom�alion is true and correa and Nat the applinnt is a resident of Udiana and
n is filed.
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