HomeMy WebLinkAboutMortgage_Riley (3)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou 7ownsnip Year
__ s FOR DEDUCTION FROM ASSESSED VALUATION
� • Sfate Farm 43709 (R17 / 6-09)
�' � prescribea by Department at LaW Govemment Fnance
File Mark
�iSTRUCTIONS:
�
To be filed in person a by mail wiN Ne CowryAUditor or Counry Recorder o! the county where the property is located.
FiHrg Dates: 7) Real Property. Must file dunng the yrear fw which the deduction is mughf. � n Audimr
2) Mo6de / Manu/aUu2d Hortres not assessed as Real Property: Must file dunng the hvelve (12) monNs ❑
befo2 March 37 of each year the deducfion is sought. u eeorder
See2versesideforaddiLOnelinstructionsandqualifiratuns. GIBSO UDITOR
e,,.,r �� i�rrrno-edb�rvv.[-SeBresfrilrntsmreversesidal �A
As�seG rapie d real P�P�Y �%d
MarCh 1, arte1R Sear
It no. what a his / her e� share ot intemst?
�( nxm¢ m �emrd is dfierent lhan Nat o( appG
�� U �U��� ��% �
Mortaage / Contraa'udebtedrress unp
Mart�h jw�t yea�
£
� �
. mtlinte Debw:
rUme a rtnrt�as� « mnvac� sener
Addrea of rtnrtgagrP w conlraG seUet (numbe� and sb
Name ot assi9nee w other owner w holder of mortga9e
AEtlress of assi9nee (numberaM sneeL c% stam, end
No 5�,�� �
_ �l �-........
_ Di�a,�-e,-1o...........
Il� I �
Does appl�^� o+m MoDenY
munry in Indana? r
L
meamoumor.
sla�, ard LP cade)
Remrd
1 as d I Mw�qage / Contre�Y cdebtednrss impaid as W Is Ne ap�t the sak
Oate of aPP��b^ � or eWdade ame(1
❑ Yes ❑ No
If owned xi� mmearie aher Ihan spouse. indicate wiN wlwm
Is ihe Oroperty in 4uestion: Mnua%ASSessed
❑ R�i �openv ❑ iq,�ua�H /usessea . . .
Nis dedutlion Ecen repuesteE an pmprlly
urtent Ye� ❑ Yes ❑
20_ 20 C81�C1 �� . ...... .. .......... � �_
uanne W Counb nuditor Counry oate (rnaiN. daY• Y��
I I We certify unde, the penalry of perjury Mat lhe above and foregoing infortnalion is We and cortecl arM that the applican[ is a resident of Indiana ard
owner / contrad buyer of the aforementio���property on date appiication is filed.
Pem,on authwaed by tluty ext
Address of authwtred Gerson
(num6eiand sLeef, ti�te, and ZIP cotle)
� Power of Attcmey or by IC 61.1-12-0.7
rm6erarid sbeet, dty, state, and ZIP code)
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