HomeMy WebLinkAboutMortgage_Johnson (3)'°+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear ,Y
_ FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 43709 (R71 / 6-09)
� Prcsaibed trl0epartmeM of local GmemmeN Finance
File Mark
wsraucnoNS:
To be filed in person w by mail wrth the CountyAUditw o� Counry Recorder o/ fhe county where tM1e property is located. F �
Filirg Dafes: 1) Real Property: Must fife dunrg Ihe }rear for which the deduction is sought. C. Aud'ROr
2) Mobile / Manufectured Homes irot euessed as Real Property: Mus[ file dunng the nvelve (12) months �
before Maich 37 0! each year the deduction rs swght. ❑ e�
GIB
See reverse side (or addilional insfi�ctfons and qualifiwtions. UDI70R
pfipnt ( arconba b - see mstrirbo�n-.�s Im�rse side)
�f'
I a�d�g Distrirl y number / legal EesciPtion Remrtl number Page numb�
a- - 3a� . 8' 7-o a lo
vWue of paperty as of hbrt¢g�a ge / Contraa indehtetlne5s unpaiE as W Mqigage I Con7a�t'vWebtedn¢s �mpaid as Of Is Ne apprxant tha mle
I Namh 1 arma y�r / 1 qi �� date of appGratm �� Yese ohmM
Ol ❑ No
Itt rw. wha� Is his l hu era� shara of interest? H wmed wiN someo� ather than sGa+�. indkate with vA�wn
I 11 fwr�e m recotE b QAlerenllhan Nat o1 aDD��• �ipte Delwr. Is tM property in Question: Mnua%ASSessed
eal Pfoperty Q MnUallyPSSessed _
Name ot nartgagee u mnvaa
A4dress W rt�txcgagee w contrad se�er (nurti6� and sL
Name M assignee or othrl ownet or haldu of mortgage
ciry, state,
Does eOWinnt ovm property in any dher
munry in Indiana? ❑ Yes
❑ No
20
sigrunae d camry aiaaor
20
ee; cdy, ste:e, aM ZIP code)
Z/P mtle)
It yes. what munt/�
20 � 2�
D1":1�1'CI' ��....�l:l.J•F.....
C�I'(1 ��. .....::•���......
�a, 3aa � S9
p
�i9
(rrnnth.
uesleE on propelty
� Yes ❑ No
20
I/ We certfy unAer Ihe penalty o( perjury that Iha above and foregoing infortna�on is We and cortec[ arM that ihe applirant is a resideni of I�iana aid
owner I wntraci buyer of the afaementimed property on date applicatlon is filed.
yawra (owners ruu napp,) � � oate (monm, der. raa�
Fun revdent eOtlress W appfi�((num0er ara snee4 d+Y, s+ate, antl LP wde)
� 1/ a o s•�.� 8s o s ow �� 5 �. •��c T�l/ y7 G�s
Person aWnraed Ey dily executetl Power of /ltlomey w Cy IC 61.7-t2-0.7
Pddress ot auNOrved person (numbor aM sbeet �: ste(o, an0 ZIP mde)
oate Imontn. dar.Y�d