HomeMy WebLinkAboutMortgage_Boyle (4).f °^� STAIEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION �
s�e F«m aa7o9 �rxe i z-0�� {
S � Presa3ed by Depariment of Local Govemmmit Finance
INSTRUCTIONS: ��a� 1 2009
To be �led in person or by mad wifh the CourrtyAuditor o(fhe courtty where fhe p/operty is bcated.
Fd'vrg Dates: 1 J Real Proper(y: During the 12 rtronths be/are June 77 0/ the year the deduction is to be elfective.
2) MobBe Hortres assessed urMer IC 61.1-7: Behveen January 75 and March 2 o(the year the deduc6on is to be ��v
See reverse side for additional insWctions ard qualificafions. �� �
OIBSON COUNT ��
nppi�ara (amer trad - see resrictiais m sde) /� � •
9� C�, yv
TakFnf Districl � n/1 Key num6er egal tlesaiption Reoord number Paga mimbel
P�P�Y �
'L�-1 - 2-202-D00. 9 - 22
1. artetq year Alartgage I ConVact intlebtedness unpaid as of Maich
°"`�"Y�` �� _ �li D a � ��
is his / her e:act share M iMeresl?
If name m remd is d'AlereM Ihan Nat
Nartre af mortgagee or
of rtarlgagee w mntraG seller (n�mber aM sfreeC df}: sfa(e. aM ZIP crode)
Nartre of assgriee a ath� owner or hdtler of mptgage
Address of assgnee
Does epplicaM own PopertY in arry other � O�' y �\�� l..Jl'+l.i� �
courrty in Inda�1 `.L.
❑Yes ❑NO ��� G
Deduc6on appmved in Ure amaun
p ,Op zp
/
Sigreture of Counrylwddw
b �''�3 /
counry
❑Yes �No
spouse. �cate with whom.
�e P��nY in question:
Real PmceM ❑ Mobile Home
20
requesled on propeNy
❑Yes ❑No
�
I/ We certify under the penalty of perjury that fhe above and foregoing infortnaUOn is We and corred and that tlie applinnts was / were a resident of
Indiana and ovmer oi fhe atwementioned property on March 1, 20
� Sg e(owners fiAlname) Date (monN. daY.Y��)
a,� c.
� f. �dent address of applica�rt (nurMer enASLeet aty. stafe. and Z!P oode)
2t��{ S� S r �[a:+iwx.� S�s 41 �.4 �"
Power of Alianey a by IC 61.1-12-.07
Addrass oi auttor¢ed pason (n�mberand sfieef, afy, sWfe.
�ate (mm(h, day, yza�