HomeMy WebLinkAboutMortgage_Bertram.a �* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES
FOR DEDUCTION FROM ASSESSED VALUATION
slate Forrn a37os (Ra � zo�
S,.w f Presvibed by Departmenl of Local Go�emmmil Finence
INS7RUCTIONS:
To 6e filed in persnn a 6y mad with the CourMyAud"rtor d fhe co�rrty wheie Me proper(y is bcated.
Fding Dafas: 1 J Real Roperty: During the 12 monMs be/are June 11 d the y=ai the deduttion is to be et(ecWe.��,p nQ
2) Mobile Homes assessed w�der IC 6-1.1-7: BeMeen January'15 end March 2 of the year tlre depycamn �i t����tWe.
See verse side /a addAional ins6�cfions arrd qualifications.
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AUDITO
T' 'G K number / I desaiplion Reoord num
eY � �n - -�flV—OV � � � �-o ��
rdue ot mal popaty as N March 1. airernY�r �O O unpaid as of March 1. �p Is 1he app6pnt Iha sde legal or equita6le wrnef
�� �y ❑Yes ❑No
Ir ryWat is his I ha rxact share af interest? If onned wdh sortieme other Ihan spouse. indirate with whom.
m
or coniraU seller
Address ot rtartgagea a
Name of asggnea or dM
iicard own property in a', ��
Indana? �!�
❑ Yes
;i
�
i ePV�'ed m the amaml of:
indimte bdow:
nber erM �cet dry, �ata, adlLP cade)
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6 �..
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Dra���er NO ...............
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CardNO . ....................
�g Dis4iclT
AUDROR
Is Ne proparty in questim:
❑ Real PmoeAv ❑ Moble Hane (IC 61.
Zo� I p— I �— I � I Za— � zo
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❑ Yes ❑ No
zo
reWre ot Caunry AudGOr co�mcr I o� (�+�. �r. r��
I/ We certify under the penalty oi perjury U�al Me above and foregoing infortnatio� is hve and mrred and Mat ihe applipnts was I were a resident of
Indiana and ovmer of the aforementimed property on March 1. 20
vut�vnlouvwJsfm�me� _ . Date(mmN.daY.Y��
-,iderit addrms of appic
��63 0
erson authar¢ed by duy eYe
Hddress of aulhoraed persm
� and sGeet, cdy. sfafe, and LP ca
o��s �--� tii
r otlLLtomey d by IC 61. -12-.07
W sfreet Wy: sfate, and LP mde)
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