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� i rt��^� STATfMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
% FOR DEDUCTION FROM ASSESSED ��� -p--� � Count Township Year
: � «. � Slale Fam 43709 (R8 / SU6) - �—�
� P�eaoibW Dy DepaNnerit of Local Gwemment Finance �1
SEP 2 5 "t��!1
INSTRf/CTIONS: File Mark
To be /iled rn person w by mail w8h the County Auditor of the county�,�y� the� y is located.
Filing Dates: 1) Real Property: During the 12 months before ,lune I1 oP'the�r th�duction is to be elfective.
2) Mobile Homes assessed unde� IC 6-1.1-7: Betw�gg�qygqUN�hd�Ahg}�ii�'2 of the year the deduction is to be elfective.
See reverse srde for additional instructions and qualifications.
�pticant (owner
� r�
�F
Taxing
see
i/ "W � n 5'r/ �� �( r
Assessed value of roaf property as of
March 1, aurenl yeer
If no, what Is
If name an record ie �ferent than that of
Key number / legal description
a� - �7-0�-¢��-aoo. o�G
Record number
Page number
MoAgage / Contrad indebtedness unpaid as of I Is the applicani the sole legal or
March 1, current year owner? ❑ Yes ❑ No
� �G� �/044
betow:
If owned with someone other than spouse, indicate with whom.
�e of mortgYgeo or eontreq seller
�,f.�zz�s s��f��a��
Addreca of rt�agee or contraq seller�numbecand street, aty, state, ZIP
Name of ae4fpnee w other avner or hold�of mortgage
(number and street, city. state, ZIP
Does appGearM own property in any other I If yes, what
munty,in Indiana9
approved In the amount of:
2o BY
20 �,� I 20
�
�
Whal Taxirn
COUNTY AUDITOR
zo
County Audftor
zo
Is the property in question:
❑ Real Prop�ty ❑ Mobile Home (IC 61.
Dra«�er NO..a� 7
, ........
Card No. ...�`y 03, —
�(DI �i d� •� . . d on
c�n� 5� �,�-{ � No
zo
Date
20
�We certify undet ihe penalty of peryury thafthe above and foregoing informalion is true and corred and that ihe applicants was / were
esident of Indiana and owner of lhe aforementioned property on March 1, 20
Signature (owners I{�II name) � Person authorized by duly execuled Power of Attorney
��,¢,h J���b� or by IC 6-1.1-12-.07
uu.taswant amresa 1 a it r� Address of authorized person
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