HomeMy WebLinkAboutMortgage_Johnson (34)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_. ; FOR DEDUCTION FROM ASSESSED VALUATION
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S w,� � Presaibed by OepaNneN a1 Lnml GovemmeN Finance '
i e Mark
INSTRUCTIONS: .
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To 6e lled in person w by maif witA Me CountyAuditw or County RecoNer o( the wunty where Ihe property is bcate�U
Filirg Da[es: 7) Real Pmperty: Musf file dunrg the year (or which Iha deduction is mughL � Counry Auditor
2) Mobde / ManuFactured Hwnes rrot assessed as Real P�oper7y Must file dunng the fweNe (12) months
6efore Ma�ch 31 of eacA year the deduction is sought �y�7 �a+�tY Recorder
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See reverse side 7or addd'mnal instructrons and quali�cations. AUDIT
Appfnyn(ywj'er9roontrartbuyer�resvic�ur�mnverseside) _
7, qmnt yea
�( M� W�Id� 6 �16 i�IPl BYM15�Nf8 Oi YI}PlPSl7
� U - lLCh/. ' - oS a /
r�� age 1 Convacc indehteEness unpaid as o( Mortc�age I Con� rtWebtedness unpaid as of Is Ne app�t the sale
mh 1, airtent yrar date af appGmlim /y�� �egal ar eQuitade avnef?
/Di C.+I�iL_J ❑ Yes ❑ No
If owned wiN someorre otheJ than spouse. Ndicate wilh hlrom
If nama m 2wN b tli9e2nt than chat oi app6cant InE'uata 6ebw.
Name of mortgagea or contracl
ier ard sveeG ray, sbte, ane LP code)
morigage
(number aM snee4 mY. slafe, and ZIP catle)
Ooes e�imnt oM+� yope�ty in any oNer
�,� �� im��
❑ Yes
amoum
20
SigruLae d Camty P�diwr
hi�7
IS CI¢ PfOp¢ItY Ill QUCSbOn: Mf1U80Y ASSG552E
❑ Real Roperly ❑ Armually Assessed
Modle Hmie OC 6
�� y T �µ NSU�
If yes, what muntyl I What Tarirg Di
COUNTYAUDROR
20 _ 20 20 _
Caunry
09- ��� 8
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1/ We certty under ihe penatty of perjury thal Ne above and foregoing infortnalion is W e and correct and Nat Ne applipnt is a resident ot Indiana and
owner I contraq buyer of the aforemerttioned property on date appiication is filed.
�rature (awneY: fiAI name) _ �ate (month. daY. Ygeh
FWI
aM sf+eq. My, stare.
C� t
� o(Attomey or Cy IC I
of aWior'ved persm (numbrrantl streef. dty. sfa�e.
Date (monlh. daY. Y��