HomeMy WebLinkAboutMortgage_Burhartn STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
: FOR DEDUCTION FROM ASSESSED VALUATION
� saca r-o� a3�as cR„ � �os�
�' � Presaibed Dy DePattmeM of Lod Govemmard Finance .
INSTRUCTIONS:
b 6e filed in person w by mad wrth the CountyAUditor w Counry Recorder o/ the counry where the property is bcated-
Fifing Dates: i) Real Pmperty: Must file dudng the }rear (or which the deduclion is soughf.
2) Mo6Re /Manufadu/ed Homes not assesced as Real Property: Must file dunng the fweNe (12) monfhs
6efwe March 37 o/each yearthe deduclion rs swght.
See reverse side tor addtione! instrucLOns and qualifications.
Ap o r or gopGacf buyer - aea myCrirL'�3 m re�xrye s�de)
II
! 1. anent yPar �/ I A
If tq, what Is ho ! her esatl sltare of intemst?
tt name m remtd is 6(terent than ttat of app8pnt,
Name of rticxtgapee a mitrart
AEdress o} rtnrnJa9ee m m�tra
��J = d�OC)�.�.o2�%—O//
�/ Contraa iMebtedness unPaid as W Mangage / Canraa ubebteArms
wrtemyear aar�maaa�� ��
If ovmeC with mmeone ofher than spouse.
i saeec
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a°g........ �,�.—�:
C:11'C� �`0. ..........
� �5,� . o�o
pe�utnon apprwed 4� tltB amouM oF.
COUNTYAUDROR
Counry Recorder
�number Pag/e� nu
U/� pC��
imPald as d 1s Ne ePW�t the sde
legal or eqWta6le awnM
� n Yes n No
p propeM1Y in QueSDOn: MmIe�Y A55e55ed
Real Property ❑ Armually Assessed
H25 �h5 d¢dYCOqI DBCII RGUPSIOj Ott QIOpPlt`/
ra a,rte�n y�n n.,_ _ r-i
20 2b _ 20 _ 20 _ 20 _ 20 _ 20 _
SignaMe W Camblwditur Counry Data (monM. CeY. 1��)
I/ We certfy under the penatty of perjury that Ne above and toregoing infortnalion is We and correct arM Nat the appiirant is a resident ot Indiana antl
rnmer / mntracl Duyer ot the�(orementianed property on date application is filed.
FW t eEtliY1S W appf^rant,(�numDe�r0end streeL a1y, sbte,�J ZI wt
� � �o/ �. �aGd �PJG�� /C��
Pason auU�a¢ed Oy dW/ ezewtetl Poner o(AttaneY a bY IC 57.7-12-0.7
Pddre� of authu'vEd puwn (numberaM sbaeL �: sta�e. and LP code)
Date (monN. OaY. Y��