HomeMy WebLinkAboutMortgage_Remington^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownsh' ar
:,--
� FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 93709 (R71 / 6-W )
�' ,�,� � Presvibetl by DepaRment of Laal Gwemmenl Frerxe
File Mark '
�NSTRUCTIONS:
F d wBh:
To be filed in person w by mail with !he CountyAUditor or Counry Recolder o/ the county whe2 the property is lacated.
Filirg Dates: 7) Real Pmperty: Must file dunrg the year for which the tleCuction is sought. dimr
2J Mobi/e / Manufactumd Homes rat assessed as Real PropeRy: Musf file dunrn� the hveHe (12) months � ��\
6efiue March 31 of each year Ne deduction is saght. Coun Remtiler
See reverse " e Ior additional insVUClions and qualificatio
G� y pun1T-j'a
A7P��t ( or aontraG bu�y,e/r-� se�e °"� on re ") . / � `
� O/J� _ Y' � i 1/J� /�71�-G �KJ
w�u5�dr�n�iasw
taamhi aa`ernyear
R ro. what is his / her exaC share oi
1f natt�e m rt.mE is OiRerent Nan U
- /- - 00 -�G/. S
n�a� i c�aza �,aw�ea�ess uroam � a i
7. wrtenl year i
Name of mort�a9� or contrarl se�er /J/ /
G(/_
AAdress of rtwrtgagee w contrad se0er (numbei arM s0
Name of asvgnee or atha owner or hdder of morigage
Ad7res5 oi assignee (number and sheet �tiy. sbte, and
Does ePplicant ovm property in any oNer
munryinlnd'ana? � Yes ❑ No
Detluctlon appfwed in �he amount of:
cM ��8. erM ZIP code)
If yes. whal couM/� � YMaI Tanrg D'sVict?
Inrtno_—
20 _ 20 _ 20 _ 20 _ .
Signatwe of Camb Aud'¢or �� � l
I/ We certi(y u�er the penalry of perjury that the above antl foregoing infa ��� C
owner 1 mntract buyer of ihe aforementioned property on date ap0�ication e
� owner5C0IDnarne��-1
i= `
I reSiErnt atldre� ot appGrant (number anASLeet. tlry.
3oP6 s yaS � Ow .., �rl
Person auUro�aeE Gy dWy ezeated Power of fUtamey rn I
antl
(numberaW saee4 ary. sb(e, and ZIP coAe)
E
I lega� «ewibde ownen
, ❑ ves ❑ No
spouse, iMicate whh whom
,I-s-/t�e poperty in question: Mnually AssesseA
y� Real Property ❑ ArmUallyAssessed
7� Mobile Flort�e OC 61.1-;
,�_
/9s,��
Has �his deductim Deen rcGUestetl m proprJty
for curtem yeaY? �_. �
lua,��� �
] � 2(1
�ate (rt�wvh. tlaY• YEa�)
licant is a resident of Indiana arW
ate (mwuh. daY. Y��)
Date (rtwnN, tlaY.