HomeMy WebLinkAboutMortgage_Mull^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co�n 7ownship Year
•r— ,
- FOR DEDUCTION FROM ASSESSED VALUATION
S1ate Wrm 63709 (R71 / 6O9) � � �?
�' �«. � Presaibed �y DeP��M of LaW Govemrtrent Frence g SL� �� ::�'
File Mark
�S7RUCT(ONS:
o be filed in person or by mail with the CounryAudito� or Counry Recortier oI the counry wh@w the � F� �� ��
4� ���-
F�Tmg Dates: 7) Real Properry: Must file during the year for which the deduction is sought. �ounry Auditnr
2) Mo6i(e / ManuFactured Homes rwt assessed as Real Property: Must file dueing the� r,�l e� {72) months
be(ore March 37 of each year Ne deduction is swght. vc \\ ❑ County Recorder
Seeieversesidelor�dditionalinsfruc8onsandqualifications. GISSON rnnnirv ai n 7nR
App&ant (owneror �ep�err; � verse _vOe) 1 A A �
Distric Keynumber/Japyeescnption
(JIYJ
Crahmd pmpertya o p�
A/amh 1. nYreni �� reV `ye�
/
If ro, what is his / her evatl sha�e of interesi?
Ii rame on rem�tl is Wiferent Nan Nat of app6rant, uWirete Oelow.
Name of rtwrtgagee or mnverl sdler
Address of mortgagee ar mntract seDa (nuniber and stree4 cify, stafe.
DCa\1'�1' ��...�U•!••.......
c��-a �o. . �..3 3�......
�
20 _
Signature W Counry AuEitor
20 _ � 20
— c� — cTw w. v —(> v � �
'vdehted�s unpaiE az W Morigage / CanVact ciEeMeOness unpad a of % Ihe al
+ _ Eate of appGqlion legal or
rc o� wim someone otl�er ihan spouse, irdicate witt, whan
Aia[ munry? I Nrtat Tapng D'vstric[?
COUNTYAUDROR
_ 20 _ 20
_ �nry
Yes Lf No
Is Me property in pues0on: MnuaP/ Assessed
❑ Real RoPenY ❑ ��Y �
for wnm� yea(.�
r���
Dale (rmVh. daY• Y'ea�)
.�i
20
I/ We certify uMV Ne penalry of perjury that' nthe above and foregoing in(ormalirn is We and comea a� Mat ihe applirant is a resident of IrMiana antl
owner I contract buyeyQf ihe afwemerrtiorFo�property on date aDP�icatlon is filed.
/ , 3. '�-D% .�
o( appl nt num0er antl street, dty, stafa. a� Z/P cotle)
. _ �'�.� \ (�, . . . �.. -, � .� . '�i /.�
Pdtlress of auNd'¢ed person (numDe� aM sveet dry. state, entl LP code)