HomeMy WebLinkAboutMortgage_Kelley^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBT� 7ownship Year
__ _; FOR DEDUCTION FROM ASSESSED VALUATION
�e����cR,,,�> MAR 9 2011
�' Presaibad by Oepartmerd of Laral Gwemmerd Flnarce
w C_�.n�,� Fle Mark
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor or Counry Recorder of the oounty wh �G�Dqg(�'/ t F0� �� `�'
Filirg Dates: 1) Real Properry: Must file during fhe year for which the deducfion is mughl. �' �"Un �%v�+��AUDITO �h �punry Aud"ROr
2) Mo6i/e / Manufactured Homes not assessed as Real Property.� Must file dunng the fweNe (72) months ���
be(ore March 37 of each year the deducfion is sought. ❑ Counry Recordu
See reverse side /w addifional insWClions antl qualificafions.
I AppGCanl (owneyaf mnfra� buyer' � rcs4rlrnsF^/evars,� sde)
LrS�
what is his / her BkaG 5hare of inte25l?
tl fwrre m �ecotd'a dRferent Nan thaf W aOP��t'uMkata 6rJaM-
Name of rtnrtgagee or mnbact
conbact seAer
Name ot assignee or oihu ovmer or hdder ot rtotgage
�
�re.
nna�ess or assgnee �numoer am sucer, rny, swe, am cir cooe�
Dces apptimnt own popeRy in any aher
munty in InEana?
❑ Yes
D�umon apprwed In tl�e amoum of:
20 20 _
i� Y�. �mai munry.
— COU
20 20
RecnN number Page rwrt�ba
a�i� o
Igage I Contraq mEebtedness u�paid as af Is Ne eppfxant Uie mk
�. o( aPP�� � a eWttable owne(1
❑ Yes ❑ No
somearre oNer ttan spouse. i`Wicate with whom
�is jtl��e P_�'Gert1' in Vuesoon: MnueDy AssesseE
L�' ��� 0 �� �
/ �aw�r�„enc��.�-
1,
�I, 0�,�,�jlf
N
k�r � . j U ��1
� p� I
4 � D�nY
L� Yes ❑ No
20 _ � 20 � 20
I/ We certify under the penalry ot perjury that the above and foregoing infortnalion is W e and correcl aM that Ne applirant is a resident of Indiana arW
owner I wntraa buyer of the aforemenlioned property on date appiiradon is filed.
�rewre (ownerSluOname) ./1 _ J_� i/ oate (mon7h. dev. Yea�
�
Gy dWy exewtetl Power dAttome'y w by IC
Address of auNa'vetl persa+ (num0er antl snee; pry, stata,
Date (rnmM. day yea�
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