HomeMy WebLinkAboutMortgage_Briner.�+� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
. 1 FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fam 43709 (R8/ 2-07)
�O y�. � presrnbed by DepaM1menl of Loral Govemment Firence
File Mark
lNSTRUCTIONS:
To be filed in person orby marl wdh the CountyAuditor of the county where fhe pmpedy is located. (aPR 1 7 Z��$
Fdmg Dates: 7) Real Prope!(y: Dudng the 12 months before June 77 of the year the deduction is to be e!/ective.
2) Mobile Homes assessed under IC 67.7-7: BeAveen January 15 end Maich 2 0( the year fhe deducSon is to be.�$eclive. ��
See reverse srcie /or additional insbuctions a� qualifications. 4�(G�
(/
Appl� t(ownu w coMiad buyer - see iestricfi m reverse s0e)
G
% n DisUia Key manber / legal desaipl'an
�-oa -3v-3oo-�
pss¢ssed ralu¢ of real popaty as of March 1. a+renl yeat Mortga9e nVad i ehti
artent ye .� �
�
If ro, wlat is h'a / hei ezaa share M interest7
i
I�on record is diflerent Ihan Ihal of applicant, indipta below:
Name of nwrigagce cont+aci seller
AOdress of mortgagee or wnUad seller (numbrsaM sYmef, oty, state. and ZlPcode)
Name of assgnee or dher owner w holtler ot morigage
Address of asvgnee (nwnber arM sGeet, city. state, aiM ZIP wde)
Dces applicant own property in arry olhv If yes, what
ca,nry in ��aia�aa
❑Yes ❑ No
Oeduction app�oved in Ihe amount of:
p � �
Sigrp�e of Counry Audbr n
2p _ I 20
O� . �'o/�
iness unpaid u of March 1,
Reoord number Page rumbm
2-00 8 �� � `(
appGpnt tha sde legal n equilaMe ame(1
)OV I ❑Yes ❑No
If owned with someone alher Ihan spouu,
Is Ihe propeM in 9�tion: .
❑ Real Prpperty ❑ Mobile Home pC G7.1-7)
�
0
� WwenY
_ a �G �, / G 7,. ❑ Na
20 _ � 20
Dale (nuanih. day, yea�
20
I I We certify un�r lhe penally of pe�ry that the abrne and foregoing infortnatio� is hve and mrrec[ and thal the applinnts was ! were a resident of
Indiana and owner of ihe aforemen ed property on March 1, 20
\/ Signalu7E�(owne/sM1dl Dale�i'wnN da eail.
} � �% Q
Iidenl address o applicant (number and streel. dly. state, aritl ZIP mde)
�i �3 N f�c��s.s �SD �• zc e pa�
Pason au1Mr¢ed by duly erzecuted Powcr af Pltarrey ar by IC G7.7-12-.07 Date (monN. Cay. year)
Address of au�hwaed persm (number aiM s6ee4 �Y. state, aM LP oode)