HomeMy WebLinkAboutMortgage_Warren"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Y
�__ . FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 93709 (R71 / 699)
�,.,. Presaibetl by DepartmeM of Laal Gm�emrtrent Fi�anca
INSTRUCTIONS:
To be lled in person or by mail with the CamryAUditor or Counry Reoorder of the county whe2 the properry is F�� ���
Frlir�g Dates: 1) Real Property Must file dunrg fhe year /or which Ne deduction is sought. � 1 � Coun Auditor
2J Mo6de /Manu/auured Homes not assessed as Real Property Mvst fi7e during the M1veHe (72) months ry
before March 37 oteach year Ne deduclion is sought. ❑ Caunty Recorder
See 2verse side lor addrfional instnutbns arrd qualifiwtiuns. �,G� �� �
' Distr&Y Key rwm6er I iegal desaiptirn R¢cortl number Page wm0er
� � a� -oa -30 - 300- Dva. a,3y-o�� � o �o�o
�esse0 �2hc Ureal poper;y a d �.lortpape / ContraG' ness un@�d as N Mortgage / ContraU "uWe6te0�ress un0aitl as of is tl�e ePP��t tha sde
amh 7. aima ym Mamh i. a�rre`rt Y� O V Cate of avP��U lega� or eQUiraNe ownM
❑ Ye5 ❑ No
m. what fs his / Icer emrt share of interest7 If awned wiN mneone other ihan spwse, IMkste wtth wtwm
name m remrd'e Etlferent than that W aPP��t 6MUate 6ebw. Is �he ProDertY in Question: MnuaOy AssesseA
�eal P'oPBrtY ❑ %vmually AssesSed . . ,
Nartre ot rtKUtgagee or mntraU seYer
Add2a o1 nnrtgagee or mntraa number and
Name N assignee w oih� owner m hddu M mortgage
AAaress of assignee (number � s1reeS d+Y, ste(e. entl
t�
Oce5 applitant own O�PenY in anY oUer
munry in Indimta?
❑ Yes ❑ No
Deduction apprwed in the amoum of:
20 _ 20
sg�wa a can,H awn« „ .
cdy, 5a:e, eM LP code)
-i -�o ,3. ao 3
What Ta�drg DistriU? Has tTis tleEUdion Eeen requestetl m pmpefty
far anenl YeaR�
� No
COUNTY AUDROR ^ W W�� � 1 � _
\.�� U�/�l.�"" �
20 � 20
cwnry
1/ We cerOfy�er the penalry of perjur�that Ne above aM foregoing infwmalion is true ai
owner n a buyer of Ne aforementioned property on date applidtlon is filed.
name)
II msident atltlrass of ag&ant num0e�fntl sLaet. dty, state, arM L ootle)
�3'as' 7'� • �G�e� Ps8 �'1 �C����9�-,. �
rson aufhwiatl Ey dWy esea;ed Power of AroomeY a bY IC 61.7-12
person (number a�M SLee; rity, state, anC ZIP ootle)
o�0/D ' � 0 (00
__. __ �e. u�e apq�nn[ is a resident of IMiana arW
b
daY. Yaa�