HomeMy WebLinkAboutMortgage_Spore^'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
>_ ,- FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Form 437091R11 / 6-09)
,,�,� P�ewibeE by DeP��� of Local GovemmeN Firence
�STRUCTIONS:
o be �led in person or by mail with Ne County Auditor o� Counry Recorder o� the county where the properry is located.
Fii'mg Dates: 7) Real Property: Must �le durirg the yearlor which the deduction is sought.
2) Mo6ile / Manu/actured Homes rwt assessed as Real Property: Must file dunng the iwelve (72J months
6efore March 31 of each year the deducfion is sought.
See reverse side (or addilion� instnictions aryJ�qualifications. � _
c( mal pfopMy as d
p opM
Y�
rc no. what fs his � her e�aa share a incemst?
v,��,,5'�-/oS- DOO ,30 � -o i
Contrarl "udehtetlness unpaid as W Mortgage I Cmbact 6deMednes
�enj�er _ Aate oi appGCation
It name m�emN is NReran ihan Nat of aDP�4 mdicate bebw.
Name M mort9agee or
ar mntraa se0er (nimber aM street �Y. �. arM ZIP oodaj
or oMer awrrer or tw
naaress ar �q�e c�mwe� a�e �
Oces appicant wm property in any oN
munry in Ind'eria? 1-'1 .,--
Fi�]
Signa4rte o(
20
1
Auditor
number Page number
35 of Is Me epprcanl tlte 5de
legal a equitable wrtce/1
❑ Yes ❑ No
rc owned wiN wmew�e otlrer ihan spouse. "umdrate uim xRnm
Drawer \'0..��..`�'.\.........
C9CC� �`�. . �`� `�:�........
�1����.I�U
zo _ � zo
Caunry
!s IM propeny in Vues6on: MnuaDy Asessed
;] Real ProPenY Q A^^uallY %�sse�d
Mo6ile Fiane fIC G1.
Nas N's CetlutYim Oeen requested m P��Y
ro, aurem r�n ❑ ves ❑
20 I 20 1 2�
I/ We certiFy under Ne penalry of pe�ury that Ihe above and (oregoing infortnation is We and cortect arM that the applipnt is a resident of IrWiana aM
owner I contracl buyer of Uie aforementloned property on date applirabon is filed.
mawn r,m nenre) n oate (,nanm. aar. r�n
exew[ed Power o(lWOmey or by IC
Adtlmss of auGrarsed persm (numberaM saee4 �1y. sbfe, and Z!P m0e)
oa� c„p,�m, e�,; �n